CME/CPD Activity Completed Form










    1. Total Credit Hours of CME/CPD provided through this Activity*
    2. How many CME/CPD Credit Hours were held by the End of the Activity? (Number of Credit Hours to be entered and need to be verified by the number of Credit Hours granted by ICHS during the application submission. The Actual Number of Credit Hours provided during the activity cannot be more than the number of Credit Hours granted by ICHS. Parallel Sessions are considered as one session and learners and participants will be given credit hours for one session for parallel sessions)*
    3. How many Learners and Participants were present during the CME/CPD activity who will be receiving a Certification of Participation?*
    4. How many Learners and Participants Per Specialty and Subspecialty?*
    5. List of Learners and Participants in the CME/CPD activity need to be downloaded into ICHS Portal specifying Learners and Participants (First Name) (Last Name); (Degree); (Number of Credit Hours Attended). (CME/CPD Credit Hours awarded need be rounded up or down to the nearest quarter hour. For example a participant attended 1.40 hours will be rounded up to 1.45 while 1.35 hours will be rounded down to 1.25 hours)*



    6. CME/CPD Content Validation and Consistency*





    7. Commercial Independence and Disclosures to Learners and Participants



    8. Summary of the CME/CPD Evaluations



    9. Commercial Support