Continuing Medical Education Activity Evaluation Form

Annals of Allergy, Asthma & Immunology Continuing Medical Education Activity Evaluation Form The American College of Allergy, Asthma and Immunology is accredited by the Accreditation Council for Continuing Medical Education to sponsor medical education for physicians. ACAAI designates each Annals CME Review Article for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credits commensurate with the extent of their participation in the activity. A. Instructions to obtain Category 1 CME Credits: 1. Read the CME article in this issue carefully and complete the activity by answering the self-assessment exam questions on the form below. 2. To receive CME credit, complete the evaluation form below and submit it to the ACAAI office within one year after receipt of the Annals. B. Quiz and Evaluation: 1. Circle answer: Q1. a b c d e Q5. a b c d e Q9. Q2. a b c d e Q6. a b c d e Q10. Q3. a b c d e Q7. a b c d e Q4. a b c d e Q8. a b c d e 2. Circle Yes or No A. The article met its learning objectives. Yes No B. I learned something new that was important. Yes No C. I verified some important information. Yes No D. This activity will influence how I practice medicine. Yes No 3. Rate the overall effectiveness of the CME activity: 5 (very effective) 4 3 2

a a

b b

c c

d d

e e

1 (not at all effective)

C. I, certify that I have met the criteria for CME credit by studying the designated materials, by responding to the self-assessment questions, by reviewing those parts of the article dealing with any question(s) answered incorrectly, and by referring to the supplemental materials listed in the references. (Sign here) (Date) D. Please indicate the issue and volume this form represents:

Year

Month

Volume

E. Hours claimed: (This educational activity is designated for 1 Category 1 CME credit). Indicate total hours claimed F. Charges Recording of Annals CME credits is provided to members of the American College of Allergy, Asthma & Immunology at a cost of $25 per year. Nonmembers will be charged $50 per year. This cost will cover processing of forms and reporting of CME credits earned during the year. Participants will be provided with an annual report on the number of CME credits earned each year. Checks are to be in U.S. funds payable to the American College of Allergy, Asthma & Immunology. G. Participant information: Name (Please print) Address City

State

Zip

Return completed form to: Attn: CME Coordinator; The American College of Allergy, Asthma and Immunology; 85 West Algonquin Rd, Suite 550; Arlington Heights, IL 60005 Fax 1-847-427-1294 VOLUME 106, MAY, 2011

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Annals of Allergy, Asthma & Immunology CME – Needs Assessment Part of the mission of The American College of Allergy, Asthma and Immunology is to better serve the CME educational needs of our membership and readership. We ask you to identify the areas of CME education that you feel need to be addressed. We will collate the subject needs yearly and plan to have certain of these educational subjects published in the Annals. Please list subjects that reflect your educational needs and interests and fax to: ACAAI at 847-427-1294

Date Name (optional)

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ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY