CE Credit 2019: Geriatric Healthcare Telehealth Series - April-June
April-June 2019 | 15.0 contact hrs | 3.0 pharmacology hrs*
19900-JP-02 | Seattle | $45 processing fee
DIRECTIONS: Submit this form to the course coordinator at the activity. Successful completion requires completion of all required activities and an evaluation. A link to your certificate will be emailed to you within four weeks.
PLEASE PRINT CLEARLY. ALL INFORMATION IS REQUIRED.
Name________________________________ Highest Degree__________ Mobile Phone____________________
Address (City, State, ZIP)____________________________ Agency Name _______________________________
Email Address____________________________Your Profession or Specialty _____________________________
ATTESTATION OF ATTENDANCE (Required for your certificate)
I successfully completed this activity and earned ________ contact hours. (Maximum you can claim is 15.0.)
Date of Activity Completion_________ Location (City, State)_____________________________
Your Signature__________________________________ Date___________________________
*Pharmacology hours at the advanced practice level.