Moderators

If you are the moderator of a MECOP-accredited CME session, please complete the information below

Conference Name*
Program Date
MM slash DD slash YYYY
Session Title
Full Name*
Your Email*
Accreditation Info:
MECOP is accredited by the ACCME to provide continuing medical education for physicians.

Disclosure:
ACCME requires VERBAL disclosure be made to all CME participants prior to the presentation. Please check that you have made the appropriate disclosure statements.
The planners of this activity:
- Do not have any relevant relationships with ineligible companies to disclose.
- Have the following relationships with ineligible companies that were disclosed to the audience
Details of relationships...

Please list member's name and nature of their relationship
The speaker(s):
- Does not have any relevant relationships with ineligible companies to disclose to the audience
- Has the following relationships with ineligible companies that were disclosed to the audience
Details of relationships...

Please list speaker's name and nature of their relationship
Provide a brief narrative summary of the session:
Tell us about the gaps in knowledge, skills, or practice for improving competence, performance and/or health outcomes that were covered during today’s session?
Tell us about the format of today's session (didactic lecture, journal club, case discussion, etc) and how it helped in closing gaps in knowledge, competence, practice or outcomes?
Additional Comments:
Was an evaluation of this session performed?
- Yes
- No
Upload session evaluations as a single PDF file
Accepted file types: pdf, docx, doc, pages, Max. file size: 100 MB.
Sign In Sheets
Accepted file types: pdf, docx, doc, pages, Max. file size: 100 MB.
Upload your sign-in sheets so we know who attended your session and can administer appropriate credit.