CHCE Evaluation Form

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Current Medicine Group Ltd and The Center for Health Care Education, LLC

This information is for CME prposes only and must be filled out in its entirety in order to receive your certificate, which will be e-mailed to you.

Personal Details

Name:
Degree:
Title:
Institiution/Company:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail Address:
(Required in order to receive your certificate electronically)

Activity Evaluation

Please evaluate the activity by checking the appropriate boxes:


(1 = Strongly Disagree, 5 = Strongly Agree)
The overall activity learning objectives were met:	1	2	3	4	5
Assess the unique diagnostic features of the disorders described and integrate that knowledge into cardiovascular assessment procedures

Assess the unique therapeutic needs of the individual patients discussed and integrate that knowledge into cardiovascular treatment regimens

Discuss the evidence base of the management regimens described and integrate that knowledge into everyday clinical practice

The individual learning objectives were met:
Pier Lambiase	1	2	3	4	5
Diagnose and manage the patient with arrhythmia in the presence of heart failure

Compare the appropriateness of different drug therapies in the management of heart failure

Discuss the role of electrical methods of treatment in patients with heart failure

Additional comments:

Was this activity fair, balanced, and free from commercial bias?
Yes No

Please rate the content presented at this activity:
Too basic Appropriate Too complex

What are the most important things you learned in this CME activity?

What topics/issues raised in this CME activity remain unclear to you?

Please indicate suggestions for future topics and/or faculty:

As a result of completing this CME activity, do you intend to change your clinical practice with regard to <<insert statement relevant to activity>>?
Yes No

If YES, please list two ways in which you will use the information presented at this CME activity in your clinical practice:

1. 2.

If NO, then please indicate reasons why:

How soon will you incorporate the information from the CME activity into your clinical practice?
Immediately 1 Month 3 Months 6 Months Never

Please indicate the number of credit hours you spent in this activity*:

*Note: Hours may not exceed <<enter number of credit hours>> hours.

May we contact you in 3 to 6 months with a brief survey to assess how you have used the information presented at this activity?
Yes No

A copy of the visitor list will be provided to the commercial supporter of this activity.
Please check here if you do not want your name included on this list.