For UConn Health Affiliated Physicians

The University of Connecticut School of Medicine designates this point of care activity
for a maximum .5 AMA PRA Category 1 Credit(s)TM. In order to claim CME credits, participants must complete the below verification/evaluation form. Please use one form for each clinical question searched.

First Name:       (* Mandatory Field)
Last Name:       (* Mandatory Field)
Degree(s):          (* Mandatory Field)
Email:                (* Mandatory Field)

Please enter the above information as you would like it to appear on your CME certificate.

Note: Your CME certificate will be sent to the email address provided in approximately 2 to 4 weeks.

1. What is the clinical topic/question researched?
  (* Mandatory Field)
2. Is this question related to (check all that apply):  (* Mandatory Field)

3. How would you define your findings?  (* Mandatory Field)

4. Please type (or copy and paste) 1-3 citations of the most relevant articles reviewed. 
  (* Mandatory Field)
5. Please check which database references were used in your research (check all that apply):  (* Mandatory Field)

6. Describe the application of your findings to your practice (check all that apply):  (* Mandatory Field)

7. If the course of management and/or diagnosis was changed, how was it changed? (check all that apply):
    If the course of management and/or diagnosis was not changed please select that option. 
(* Mandatory Field)

1. Define the difficulties in finding relevant information (check all that apply):   (* Mandatory Field)

2. Was this activity fair, balanced, and free from bias?  (* Mandatory Field)
If “no”, please explain:
3. Rate the overall effectiveness of this activity:  (* Mandatory Field)
Poor                                                 Excellent
4. Check all that apply:  (* Mandatory Field)

5. Overall Activity: Comments/Suggestions:


Please allow 2 to 4 weeks for your CME certificate to arrive via the email address provided.


Thank you!