CME Forms for Planners
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CME Forms for Planners 

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Dear Course Director:                                                            Click here for a list of available forms 

Your interest in planning an educational activity with Sentara Healthcare is appreciated.  As an accredited sponsor of Continuing Medical Education, Sentara Healthcare follows the standard policies developed by the Medical Society of Virginia Intrastate Accreditation Committee in the development of CME activities.  The Sentara Healthcare Physician Education office staff has created a packet to assist you with this process, and they are available to work with you in the design of the activity.

The planning packet and the attachments will serve as a guide in the planning and implementation of the activity, as well as the completion of the Application for Category 1 Designation of the Credit.  After an initial meeting with the Manager of Physician Education, please review the packet, complete the proposal with your planning group, and submit the appropriate documents to the CME Office. Your proposed CME activity application, with the appropriate documentation, will then be placed on the agenda for the next CME Committee meeting.  You may be notified to attend the meeting to discuss the details.

 In order to allow enough time for planning and documentation, as well as promotion of the activity, it is requested that materials be submitted to the CME Committee at least 90 days prior to the first scheduled meeting, while those ongoing activities (weekly, monthly, etc.) currently in progress require at least 60 days.

 If it is your first experience in CME activity planning, it is strongly recommended that you work closely with the Manager of Physician Education to help ensure success.  Please call the CME Office at 757-552-7473 or 757-363-6147 to arrange assistance.

Thank you for your participation in Continuing Medical Education at Sentara Healthcare.


 Sameh Basta
MD, MMM, FACP, CPE, Medical Director, Optima Health, Medical Director, Physician Education

Perry C. Francisco, RN, MSA
Manager of Physician Education

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3.3b Acknowledgement Form to be SIGNED.doc3.3b Acknowledgement Form to be SIGNED
3.3A Speaker and Planner Disclosure Form.doc3.3A Speaker and Planner Disclosure Form
1.3 CME Mission Statement.doc1.3 CME Mission Statement
1.2 CME Planning Packet Contents.doc1.2 CME Planning Packet Contents
1.1 Letter to Course Director.doc1.1 Letter to Course Director
1.4 MSV Essentials and Standards.pdf1.4 MSV Essentials and Standards
2.0 10 Tabs Face Sheet.doc2.0 10 Tabs Face Sheet
2.1(1) Speaker Checklist.doc2.1(1) Speaker Checklist
2.3c (2) Invitation Letter WITHOUT Grant.doc2.3c (2) Invitation Letter WITHOUT Grant
1.6 Activity Application.doc1.6 Activity Application
2.4(4) Participant Follow-up Evaluation.doc2.4(4) Participant Follow-up Evaluation
2.3a CME Flier for Outside Program.doc2.3a CME Flier for Outside Program
1.6a Planning Time Line.doc1.6a Planning Time Line
2.3b (2) Powerpoint Loop WITHOUT Disclosure.ppt2.3b (2) Powerpoint Loop WITHOUT Disclosure
2.3b (1) Powerpoint Loop with Disclosure.ppt2.3b (1) Powerpoint Loop with Disclosure
2.1(2) Speaker Credit Form.doc2.1(2) Speaker Credit Form
3.3c Sentara Healthcare Letter of Agreement.doc3.3c Sentara Healthcare Letter of Agreement
1.5 MSV Update on Commercial Support.pdf1.5 MSV Update on Commercial Support
1.7 Writing Measurable Objectives.doc1.7 Writing Measurable Objectives
2.3c (1) Invitation Letter WITH Grant.doc2.3c (1) Invitation Letter WITH Grant
2.4 (3) Service Satisfaction Survey.doc2.4 (3) Service Satisfaction Survey
2.4 (1) Evaluation with Disclosure.doc2.4 (1) Evaluation with Disclosure
2.4 (2) Perforated Evaluations without Disclosure.rtf2.4 (2) Perforated Evaluations without Disclosure
2.1(3) Linking Needs to Desired Result.doc2.1(3) Linking Needs to Desired Result
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