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Medication Reconciliation Evaluation Form

Directions
To obtain your CME credit, fill out the form and click "submit form"; you will receive a printable PDF of your certificate.  If you want to retain a copy of the evaluation form on this page (and your answers) for your records, print this page before clicking the "submit form" button.

Please answer the following questions related to this educational activity.
(*) indicates required fields.

*After completing this activity I am able to:

1. Describe Medication Reconciliation principles and process

2. Distinguish the physician's role in the Medication Reconciliation process

3. Integrate patient-centric aspects of Medication Reconciliation into practice

4. Create a medication management plan with my patients

5. Integrate principles and process into practice in all settings of care

6. Indentify appropriate Medication Reconciliation team in settings of care

7. Identify proper delegation of clinical and nonclinical Medication Reconciliation responsibilities

8. Lead my organization's efforts to support Medication Reconciliation

*This activity effectively targeted my needs.

*I would recommend this activity to a colleague.

*Please list at least two strategies that you will implement as a result of this activity:
Strategy 1*

Strategy 2*

Other strategies

*Did you perceive any commercial bias in this activity?
Yes
No

If yes, please specify

*How could this activity be improved?

Only physician participants (MD, DO, or equivalent international medical degree) are eligible to receive AMA PRA Category 1 Credit™. Physicians will receive a certificate of CME credit, indicating one (1) AMA PRA Category 1 Credit™. Physicians must complete this form to receive AMA PRA Category 1 Credit™.

*First name

Middle initial

*Last name

*Degree

ME number1 How do I find my ME number?

*Date of birth2 (mm/dd/yy)

*E-mail address (required for certificate)

*Total credits claimed


1 The medical education [ME] number is an 11-digit number assigned to every physician in the US by the AMA for identification and recording of basic information. The ME number is found on the AMA membership card.

2 Date of birth assists in uniquely identifying physicians for purposes of credit processing.

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