Forms & Documents

Title Description Who Should Download?
Joint-Sponsor Questionnaire (Acrobat document) Use this form if you are interested in collaborating with UNTHSC on CE activities Potential joint sponsors
Joint-Sponsor
Activity Questionnaire
(Word Document)
Use this form to request UNTHSC review a proposed activity for potential joint sponsorship or co-providership. Potential joint sponsors or others with an idea for an activity that meets an identified need.
Performance Improvement CME Request Performance improvement (PI) CME activities describe structured, long term processes by which a physician or group of physicians can learn about specific performance measures, retrospectively assess their practice, apply these measures prospectively over a useful interval, and re-evaluate their performance. Anyone with an idea or specific need for a continuing education activity
AOA Preceptor Credit Reporting Form Department liaisons should use this form to report preceptor credit to the PACE Office. Clinical/Educational Department Liaisons
AOA Teaching Credit Reporting Form Department liaisons should use this form to report teaching credit earned by faculty members to the PACE Office. Clinical/Educational Department Liaisons
AOA Healthcare Facility Report Hospital Education Representatives with whom PACE works should use this form to report educational activities at a healthcare facility. Hospital Education Representatives
Credit Request Form Use this form to request credit for a UNTHSC-sponsored activity you have attended if you have misplaced the form you received at the activity. Healthcare providers requesting credit for a CME or CE activity
PRA AMA Category 2 Self-Documentation Form Use this form to document PRA AMA Category 2 credits in your files AMA-member physicians who have earned category 2 CME credits (not sponsored by an accredited provider)
Faculty Expense Report Form General form for faculty members requesting travel expenses or speaker fees CME or CE faculty members who have misplaced the original expense report
Disclosure and Conflict of Interest Resolution Policy UNTHSC's policty on identification and resolution of conflict of interest Any presenter or potential joint sponsor
Faculty Disclosure Form Faculty disclosure and conflict resolution form Presenters at a CME or CE activity.
Monograph Request Use this form to suggest a CME-certified printed monograph. Original authors or co-authors
Call for Presentations Use this form to submit a CME-or CE-certified presentation you would like to provide. Potential presenters
Transcript/Certificate Request (fax) Request a transcript or certificate for UNTHSC-sponsored activities Activity participants
ACCME Standards of Commercial Support The most current Standards of Commercial Support released by the ACCME Commercial supporters, joint sponsors and/or attendees
CME/CEU Requirements by State A listing of CME requirements by state Physicians

Grand Rounds
Wednesdays - 12 to 1 PM
(unless otherwise noted)
For more information call (817)735-2539 or e-email register@hsc.unt.edu
November 25
Canceled due to Thanksgiving