Beacon Health System



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PROGRAM TOPIC

PROGRAM DATE:

SPEAKER:

Program Objectives

At the end of this activity, attendees should be able to:

• A

• B

• C

Please give us your opinion by completing this evaluation—check appropriate response.

| |Strongly Agree | |Disagree |Strongly Disagree |N/A |

| | |Agree | | | |

|Speaker – Effectively presented the information and answered | | | | | |

|questions relevant to issues | | | | | |

|Program – Addressed program objectives and met learning needs | | | | | |

|Program – Material presented relevant to my practice | | | | | |

|Program – I will make appropriate practice changes based on this | | | | | |

|information | | | | | |

| |

|Did the speaker show any bias toward a specific commercial product? | | |

| |YES |NO |

|I was present for the financial interest disclosure made prior to presentation | | |

| |YES |NONO |

Please check the appropriate box below regarding your role:

Physician Nurse Other, specify: _______________

Name (Please print clearly):________________________________________________________________________________________

PHYSICIANS and ACP’S ONLY: PLEASE COMPLETE THE FOLLOWING SECTIONS

Based on the information presented at the above mentioned CME activity:

Please rate the projected impact of this activity on your competence, performance, and patient outcomes*:

Note: competence is defined as the ability or strategy to apply knowledge, skills, behavior/attitude and judgment in practice (knowing how to do something).

|Did this activity clarify or reinforce principles and concepts that affect your patient outcomes? | | |

| |YES |NO |

|Based on this activity will changes occur to your practice | | |

| |YES |NO |

Please list any changes you will implement as a result of this activity:

Are there any barriers preventing you from implementing what you have learned today? ____YES ____NO

If yes, please share:

Please describe any clinical situations that you would like to see addressed in future educational activities:

Comments:

Additional comment may be written on the back. THANK YOU for taking the time to complete this evaluation!

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2020 Beacon Health System Evaluation

Date:

Topic:

Speaker:

Learning Objectives: At the conclusion of this program the participants should be able to:

• Review how prevalence of food allergy and development of tolerance to certain foods is changing over time

• Develop understanding for new guidelines that have been developed for primary prevention of peanut allergy, and learn how and when to introduce highly allergenic foods

• Review the utility of current and new therapies for food allergy

Accreditation Statement:

The Beacon Health System is accredited by the Indiana State medical Association to provide continuing medical education for physicians. Beacon Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity."

Summary of Financial Disclosures:

The speaker, ___________________, discloses that there is no financial conflict or arrangement present with any commercial interest for participating in this presentation. The following members of the Beacon Medical Education and Program Committee have disclosed that there is no financial conflicts or arrangement present in planning this education activity:

|Donald Zimmer, DME Memorial |Dave Van Ryn, DME Elkhart |

|Nikhil Patankar, Pediatric Intensive Care |Sandy Morgan, Pediatrics |

|Greg Ebersole, Orthopedics |Darren Dolly, OB/GYN |

|Luke White, Pulm-Critical Care |Kathryn Kenney, Psychiatry |

|Kashif Shaikh, Neuro Surgery |Troy Weirick, Cardiology |

|Mathew Kallookulangara, Hospitalist |Mohamaad Jahanghir, Hospitalist |

|Frances Baccus, Anesthesia |Gene Grove, Pain Management |

|Alex, Tawrdors, Radiology |Scott Ludwig, Emergency Medicine |

|Mark Thompson, General Surgery |Justin Grannel, Family Medicine |

|Kristine Jennings, FP Residency Med Director |Tracy Mitchel, APC |

|Mark Fox, IUSM Associate Dean |Stacy Jackson, IUSM DME |

|Lori Harding, Medical Library |Jenai White, CME Coordinator |

|Linda Magnuson, CME Coordinator | |

Commercial Support Disclosure:

No commercial support was provided for this CME activity.

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CONTINUING MEDICAL EDUCATION

ACTIVITY EVALUATION

Beacon Health System designates this live activity for a maximum of one (1) AMA PRA Category 1 credit(s)(. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Revised 01/2020

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