Educational Provider Name/Department

(Educational Provider Name/Department)

Presents

Type of Activity

ADDTitle (if applicable)

ADDSpeaker

Institution Affiliation

Target Audience:

Goal:

Objectives:

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Activity Completion Requirements:

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Date:

Time:

Location:

For registration information, please contact program coordinator (insert name of coordinator) at (insert telephone #) or (insert email address)

PhysiciansNursingSocial Work

Registration Access: Code: CPEM xx-xx| CPENxx.xx | CPES xx-xx

Physician Accreditation Statement

NYC Health + Hospitals is accredited by The Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians.

NYC Health + Hospitals designates this (enter type of learning activity)for a maximum of (insert credits hours)AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Nursing Accreditation Statement

NYC Health + Hospitals is an approved provider of continuing education by New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. P#NYP264-11/16-19.

NYC Health + Hospitals designate this (enter type of learning activity) for continuing nursing education provider unit award of (insert credits hours) contact hours.

Social Work Accreditation Statement

NYC Health + Hospitals Continuing Professional Education Program is recognized by the New York State Education Department State Board for Social Work as an approved provider of continuing education for licensed social workers #0074.

NYC Health + Hospitals designate this (enter type of learning activity) for a maximum of (insert credits hours)contact hours.

Physician Assistant Continuing Education

The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™from organizations accredited by ACCME or a recognized state medical society. Physician Assistants may receive a maximum of (same as physician credits hours)hours of Category 1 credit for completing this program.

Nurse Practitioner Continuing Education

The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™from organizations accredited by ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Disclosure Statement

Participating faculty members and planners (Choose one) have no relevant financial relationship(s) to disclose. OR have disclosed the following financial relationship(s): (enter type of relationship).

This (enter type of learning activity) does not receive any financial support or in-kind contribution from commercial companies.

There (Choose one) is a participant fee of $____ ORis no participant fee associated with this activity.