Continuing Education Credit Form

Diabetes Type I
 

The American Association of Colleges of Nursing will award 1.5 contact hours of continuing education (up to a total of 15 hours for the entire Bench to Bedside series) for viewing this tape/CD-ROM as an educational activity.  This Continuing Education Credit (CEC) Form must be submitted to verify you viewed the tape/CD-ROM and earned the credit. 

Steps

1.      Print this copy of the Continuing Education Credit Form

2.      View the videotape or CD-ROM

3.      Complete all information requested

4.      Copy the completed form for your records of contact hours earned.  No additional verification will be sent to you.

5.      Send original copy of completed form to:  CenterNet/HMTV,  529 14th Street, N.W., Suite 1292, Washington, DC 20045

Diabetes Type I is part of the Bench to Bedside Video/CD-ROM Series for clinicians.  At the conclusion of this activity, the learner will be able to:
• Understand the current research in prevention of type1diabetes
• Understand newer approaches to type1diabetes management
• Review key current recommendations for care of patients with type1diabetes
• Review key findings from clinical trails on which these recommendations are based.
• Identify collaborations needed for successful management of type 1 diabetes
• Identify strategies to establish a collaborative approach to care with both health professionals an the person with type 1 diabetes

(Please print)

 

Name________________________________________________ RN License # and state______________________
                        (Last)                         (M.I.)                        (First)

Address______________________________________________ City/State/Zip_____________________________

 

Date tape viewed______________ CE form printed on:    Signature  _____________________________

 

 

1.   Relationship to program purpose. Learning objectives for “Diabetes Type I” support the overall purpose for which the series is designed.
___Yes   ___Partially   ___No
       

2.  Objectives   Has this program enabled you to have a better understanding of the objectives  listed above:
___Yes   ___Partially   ___No       

   

3.   Presenters

Please rate effectiveness of each presenter:

Judith Fradkin, MD	_____Somewhat Effective	_____Effective	_____Very Effective
Martha M. Funnell, MS, RN, CDE	_____Somewhat Effective	_____Effective	_____Very Effective
Jay S. Skyler, MD	_____Somewhat Effective	_____Effective	_____Very Effective

4.   Overall Program

Overall this educational activity was:   _____Marginal                       _____Good               _____Excellent

      Comments: