Continuing Education Credit Form

Sleep Apnea: Is Your Patient at Risk?
 

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

Sleep Apnea: Is Your Patient at Risk 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:
• Identify sleep history questions that can aid the diagnosis of obstructive sleep apnea
• Describe the common signs and symptoms of obstructive sleep apnea
• List the cardiovascular and other consequences of chronic sleep apnea or sleep-disordered breathing
• Explain treatment options including those that a primary care physician can initiate as well as those requiring more specialized care
 

(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 “Sleep Apnea: Is Your Patient at Risk” 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:

Edward Haponik, MD	_____Somewhat Effective	_____Effective	_____Very Effective
Carl E. Hunt,MD	_____Somewhat Effective	_____Effective	_____Very Effective
Richard Millman, MD	_____Somewhat Effective	_____Effective	_____Very Effective

4.   Overall Program

Overall this educational activity was:   _____Marginal                       _____Good               _____Excellent

      Comments: