Forms

St. Francis is accredited to provide AMA PRA Category Credit(s) ™ by the South Carolina Medical Association (SCMA) through the Accreditation Council of Continuing Medical Education (ACCME). The ACCME and SCMA requires procedures be instituted to ensure compliance with all ACCME and SCMA Elements and Policies.

Please note

  • There are forms and documentation required to be completed before an activity can be certified for credit by the CME Committee (see below.) The CME Committee meets on the 4th Monday of every month.
  • All marketing materials must be approved by the CME Coordinator prior to distribution. This includes flyers, posters, brochures, email blasts, and regular mail.
  • It is against ACCME, SCMA, and St. Francis policies for activities to be advertised as approved for CME credit until approval is received from the CME Committee. In addition, phrases like “CME credit pending” or “credit applied for” may not be used.
  • Please maintain budget records for any items, catering, and speaker fees, etc. At the end of the activity a financial spreadsheet will have to be submitted.

Required Forms and Policies

Application
Completed applications should be submitted to the St. Francis Professional Development and Education Coordinator 

Needs Assessment Documentation/Planning Process Form
Applications must show evidence of need for proposed activity topics. See attached examples of how to identify needs.

Honoraria Policy
This policy must be adhered to for all guest speakers.

Written Agreement for Commercial Support and Policy
The Written Agreement for Commercial Support must be completed and signed by any manufacturer or commercial health care company prior to the activity. Any company that provides financial support to a CME activity will need to a sign an agreement for commercial support. Support includes, but is not limited to, meals and refreshments. If your activity will have any Commercial Support contact the Coordinator, Professional Development and Education immediately for instructions.

Disclosures
Every speaker and each planning committee member is required to sign a disclosure form that will show any relevant financial relationships. It is imperative to have this form signed prior to having them participate in the planning process of a CME activity. Once disclosures are received, the Professional Development and Education Coordinator will review to determine if there is a possible conflict of interest. If there is an identified conflict or possible conflict, the Professional Development and Education Coordinator must find a resolution prior to continuation. In addition, please make sure all your speakers and program planners receive Content Validation Guidelines to use in preparation of their talk.

Script for Verbal Disclosure
Before all activities, each presenter/speaker must make a verbal disclosure to his/her audience. Disclosures are mandatory as this will prepare the audience for the information they are going to receive. A sample script for speakers and/or instructors to disclose their financial relationships and/or mention of non-FDA-approved products is attached and should be strictly adhered to as this verbal disclosure must be verified by the activity director’s signature on the Verbal Disclosure Form. A written handout for attendees with disclosure information for all speakers and program planners will also be used, but not in place of a verbal disclosure.

Verbal Disclosure Verification Form
THIS FORM IS TO BE COMPLETED BY THE ACTIVITY DIRECTOR OF THE CME PROGRAM ONLY - NOT THE SPEAKERS. This form is to be signed by the activity director, confirming that financial disclosures were reviewed prior to each session, conflicts of interest were resolved, and disclosure of such were released to the attendees prior to the activity. This form (to be submitted after the presentation to the Professional Development and Education Coordinator) confirms that disclosures were made to attendees.

CME Activity Check List
Use this list to make sure you understand your responsibilities as activity director and the responsibilities of this office in order to meet application requirements.

Post Activity Evaluations
The Professional Development Coordinator will work with you to create.

Other Forms

 

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