As a Coordinator of an accredited CE Activity, I agree to fulfill these requirements:

 

 

1 Start 2 Complete

CE Activity Title *

I agree to fulfill the following: *

	Yes	No
Read the MCW CE policies as posted on MS OneNote and/or the CE Coordinators Corner within EthosCE®	Read the MCW CE policies as posted on MS OneNote and/or the CE Coordinators Corner within EthosCE® - Yes	Read the MCW CE policies as posted on MS OneNote and/or the CE Coordinators Corner within EthosCE® - No
Facilitate the identification and mitigation process of relevant financial disclosure for all persons in control of content	Facilitate the identification and mitigation process of relevant financial disclosure for all persons in control of content - Yes	Facilitate the identification and mitigation process of relevant financial disclosure for all persons in control of content - No
Track and manage attendance data in EthosCE®	Track and manage attendance data in EthosCE® - Yes	Track and manage attendance data in EthosCE® - No
Educate learners on how to claim credit for this CE Activity	Educate learners on how to claim credit for this CE Activity - Yes	Educate learners on how to claim credit for this CE Activity - No
Manage and maintain my assigned CE Activity within EthosCE® and/or MS® OneNote	Manage and maintain my assigned CE Activity within EthosCE® and/or MS® OneNote - Yes	Manage and maintain my assigned CE Activity within EthosCE® and/or MS® OneNote - No
Facilitate the distribution and collection of CE Activity evaluations	Facilitate the distribution and collection of CE Activity evaluations - Yes	Facilitate the distribution and collection of CE Activity evaluations - No
Ensure correct accreditation language on all promotional material used to advertise the continuing education activity including EthosCE®, social media, websites, and print materials	Ensure correct accreditation language on all promotional material used to advertise the continuing education activity including EthosCE®, social media, websites, and print materials - Yes	Ensure correct accreditation language on all promotional material used to advertise the continuing education activity including EthosCE®, social media, websites, and print materials - No
Retain a comprehensive continuing education activity file which includes complete compliance data for a minimum of six years from the activity start date	Retain a comprehensive continuing education activity file which includes complete compliance data for a minimum of six years from the activity start date - Yes	Retain a comprehensive continuing education activity file which includes complete compliance data for a minimum of six years from the activity start date - No
Submit all income and expenses associated with the continuing education activity	Submit all income and expenses associated with the continuing education activity - Yes	Submit all income and expenses associated with the continuing education activity - No
Promptly inform of Office of Continuing Professional Development of any changes to the CE Activity including but not limited to changes in: CE Coordinator, CE Activity Director, cancelation or postponement of CE Activity, funding the CE Activity, the date, time, or location of the CE Activity	Promptly inform of Office of Continuing Professional Development of any changes to the CE Activity including but not limited to changes in: CE Coordinator, CE Activity Director, cancelation or postponement of CE Activity, funding the CE Activity, the date, time, or location of the CE Activity - Yes	Promptly inform of Office of Continuing Professional Development of any changes to the CE Activity including but not limited to changes in: CE Coordinator, CE Activity Director, cancelation or postponement of CE Activity, funding the CE Activity, the date, time, or location of the CE Activity - No

For activities with MOC credit, I agree to:

	Yes	No
Ensure the CE Activity includes an evaluation that is designed to assess changes in learners’ competence, performance or the impact on patient outcomes.	Ensure the CE Activity includes an evaluation that is designed to assess changes in learners’ competence, performance or the impact on patient outcomes. - Yes	Ensure the CE Activity includes an evaluation that is designed to assess changes in learners’ competence, performance or the impact on patient outcomes. - No
Inform learners about what they need to do to earn MOC credit, including participation in the evaluation component. This is sometimes referred to as a “participation threshold.”	Inform learners about what they need to do to earn MOC credit, including participation in the evaluation component. This is sometimes referred to as a “participation threshold.” - Yes	Inform learners about what they need to do to earn MOC credit, including participation in the evaluation component. This is sometimes referred to as a “participation threshold.” - No
Provide feedback to the learner about their engagement with the activity, and whether the learner met the requirements to earn MOC credit for the activity.	Provide feedback to the learner about their engagement with the activity, and whether the learner met the requirements to earn MOC credit for the activity. - Yes	Provide feedback to the learner about their engagement with the activity, and whether the learner met the requirements to earn MOC credit for the activity. - No

CE Coordinator - Name *

CPD Activity Director - Name *

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