Joint Provider Checklist

Joint Provider Checklist

Below is a checklist of items that will need to be submitted/ collected for review before and after the activity.  CLICK HERE to download a pdf of the checklist.

Joint Provider Completed CME application
(responsible for submitting) Planning notes, minutes, etc.
Brochure/program book/announcement/copy of all docs/screenshots advising learners about activity)
Learning objectives from all speakers
Detailed FINAL agenda/outline showing activity schedule, length of sessions/modules, topic/content description of each session/module, and logical sequencing of topics to achieve activity objectives to determine amount of CME credit that will be designated for the activity
Roster of all individuals involved with planning and reviewing content (planning group/editorial board/advisory board/ committee members/COI resolvers/staff, etc)
Roster of all individuals involved with creating and delivering content (faculty/authors/subject matter experts/moderators, etc)
Disclosure forms for ALL individuals in control of content
Evidence that you implemented your mechanism(s) to resolve conflicts of interest for all individuals in control of content prior to the start of the activity (all completed COI forms/audit reports that document how all relationships were resolved
Evaluation Summary
Participant List
Payment for CME Credits
Submit if the activity is an enduring material, internet enduring material, or journal-based CME
The CME product or if online the url & login info (submit archived version of this activity in its entirety as it must be retained for a minimum of 6 years – hard copy, electronic version of activity, screenshots, or pdf)
Submit if the activity received financial support
The income and expense statement for this activity that details the receipt and expenditure of all the commercial support (final budget that lists all income and expenses)
Each executed commercial support agreement for the activity (all signed letters of agreement, LOAs, and any other financials agreements for all income and/or in-kind support received for the activity)
The commercial support disclosure information as provided to learners (copy of how you disclosed all sources of financial/in-kind support to learners before activity started – grid, verification requirements, etc)
LA AAP  CME application
(responsible for collecting) Speaker forms
CME credit statements
Evaluation questions
Verification Requirements
Participant List Template
LOA (if commercial support is received)
CME certificate template
Invoice for CME credits
Send out 6 week follow up survey
Enter activity in PARS
Speakers Speaker information form
(responsible for submitting) Activity planning form
Disclosure form
CV
Bio
Professional Photo
Presentation

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