Document Name

Who Should Complete the Document

Submit Document

Document Location

Document Format

 Application

 Lead Physician

12 months prior to the
start of the activity 
Request from the OCPD Office

MS Word

Recommended/Actual TimelineCE CoordinatorStart of Pre-planning

EthosCE

MS OneNote

MS Word

 Financial Disclosure 

 CE Coordinator

 Start of Pre-planning

EthosCE

MS OneNote

EthosCE
Resolution of Conflict of InterestCE Coordinator
Start of Pre-planning
(when applicable)

EthosCE

MS OneNote

EthosCE

Curriculum Vitae

(required when seeking APA, AAPA, AANP) Credit Types

CE CoordinatorUpon notificationRequest from Individual(s)EthosCE
Promotional MaterialCE Coordinator2 weeks prior to distributionCourse PlannerAdobe PDF
Written Letter of Agreement
Lead Physician
CE Coordinator
OCPD Staff
Upon notification of Grant ApprovalGrantor
Internet Explorer
Adobe PDF
Attendance RecordsCE CoordinatorWithin 60 days of Activity CompletionEthosCEEthosCE
Final BudgetCE CoordinatorWithin 60 days of Activity Completion
EthosCE
MS OneNote
EthosCE
Evaluation SummaryCE CoordinatorWithin 60 days of Activity CompletionEthosCE
EthosCE
Adobe PDF