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 |