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THE JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE

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THE JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE

Peer Review Volunteer Form . Journal of the American Board of Family Medicine. Name, Academic Degrees: Email (preferred, then alternate, if any): Phone:

http://www.jabfm.org/site/misc/PeerReviewForm.doc

Date added: November 18, 2011 - Views: 36

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Should we include something about the Board Members need to ...

PHYSICIAN REVIEW Study #1 Study #2 Report Format Interpretation Accuracy Study #1 Study #2 ... Peer Review QI Form (SAMPLE) Title: Should we include something about the Board Members need to be from accredit labs and if their lab expires, ...

http://www.intersocietal.org/vascular/forms/Peer_Review_QI_Form.doc

Date added: March 7, 2013 - Views: 8

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Physician Peer Review in a Just Culture

Disruptive Physician Policy. Physician Peer Review. It is important to realize that Physician Peer Review does not replace the managerial responsibilities of the HCO. The following Flow Chart attempts to show how Physician Peer Review is integrated into the management of the organization.

http://www.mha-apps.com/media/maps/Physician%20Peer%20Review%20in%20a%20Just%20Culture.doc

Date added: October 13, 2011 - Views: 52

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COPE Behavioral Services, Inc

PHYSICIAN PEER-REVIEW FORM. Patient ID#: Name of reviewer: Name of clinician: REASON(S) FOR PEER REVIEW. Random chart audit Referred by QM department Complaint Staff credentialing process Incident report Adverse drug reaction

http://www.copecommunityservices.org/cmmanual/QM%20physician%20peer-review%20form.doc

Date added: September 18, 2013 - Views: 14

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SAMPLE POLICY AND PROCESS FOR CREDENTIALING AND PRIVILEGING ...

The applicant has listed you as a peer who will be willing to provide a recommendation. ... Medical Staff Coordinator Sample Peer Recommendation Form. CONFIDENTIAL Professional Peer Reference & Competency Validation. Page 1 of 2.

http://www.kathymatzka.com/Downloads/Peer_Reference_Letter.doc

Date added: December 16, 2011 - Views: 222

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North County Health Services - A.T. Still University

NORTH COUNTY HEALTH SERVICES. Physician/Mid-Level Provider Peer Review Audit Form. Center: Chart#: Provider: Date of Index Visit: Date of Audit:

http://www.atsu.edu/wcn/Provider%20Peer%20Review/NCHS_Peer_Audit_Tool.doc

Date added: November 22, 2012 - Views: 22

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ED PHYSICIAN PEER EVALUATION - Jay Kaplan

ED PHYSICIAN PEER EVALUATION. Date: ... Review of this physician’s charts when performing follow up care 1 2 3 4 5 or chart audit demonstrates quality medical care and good judgment. ... that you especially enjoy working with please share this information on the back of this form and why.

http://jaykaplanmd.com/tools/ed_physician_peer_evaluation_kaplan.doc

Date added: April 1, 2013 - Views: 12

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NEW PHYSICIAN - ASPR

Independent Physicians. Attachments: - Orientation Tour Checklist. Physician Preceptor . Checklist ... Inform Medical Staff/Peer Review Coordinator and Director of Managed Care that new physician has signed contract for credentialing and contracting purposes.

http://c.ymcdn.com/sites/www.aspr.org/resource/resmgr/imported/Form-New%20Physician%20Orientation%20Checklist.doc

Date added: May 5, 2014 - Views: 18

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PEER REVIEWER IDENTIFICATION SURVEY - TOA - Welcome to the ...

TOA wishes to give members a forum to document their Peer to Peer Reviewer complaints so that we can carefully analyze those complaints before sending them to TDI/DWC.

http://www.toa.org/ecard/2006/09-2006/5th/Forms/PEER%20REVIEWER%20ID%20Survey-printout-form.doc

Date added: October 27, 2011 - Views: 21

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Trauma Case Review - Montana Performance Improvement Network ...

Trauma Case Review. ... Trauma Form used? ( Yes ... Refer to Multidisciplinary Trauma Committee or Medical Staff Peer Review Process) Tertiary – Multidisciplinary Trauma Committee review for education, Medical Staff Peer Review, RTAC, &/or STCC.

http://www.mtpin.org/docs/Peer%20Review%201%20Trauma%20Case%20Review%20Form.doc

Date added: March 6, 2012 - Views: 19

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Trauma Center Performance Improvement and Patient Safety Plan

Trauma PI issues will be documented on the “Trauma Review Form ... Provider Peer Review-issues identified in the review that deal with specific cases and provider issues that arise. ... Trauma Director/Other Physician Review:

http://www.healthy.arkansas.gov/programsServices/injuryPreventionControl/TraumaticSystems/Documents/trauma/Resources/StateTraumaPerformanceImprovementSafetyPlan.doc

Date added: July 29, 2012 - Views: 36

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PEER REVIEW - A.T. Still University

Peer Review. Submission by Ken Morris, MD. Getting Started. A system of peer review should be considered an integral component of any Quality Assurance program.

http://blogs.atsu.edu/ee/wcndocs/WCN_Clinical_Directors_Toolkit_Peer_Review.doc

Date added: May 2, 2013 - Views: 28

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Performance Improvement Peer Review Process

The original PEC members are those who remained involved in the process and dedicated their time to help form this committee. Q: ... The physician feedback report will be distributed every 6 months ... How will this new process affect the educational component of peer review at department meetings?

http://www.stlukesonline.org/for_physicians/committees/documents/PECFAQ.doc

Date added: September 30, 2013 - Views: 1

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Policy and Procedure Approval Form - HCA Ethics

CMS memorandum to the Peer Review Organizations entitled “Use of Physician Query Form” with Policy Clarification of Temporary Suspension of January 22, 2001, dated March 21, 2001.

http://ec.hcahealthcare.com/CPM/REGSCOD012%20Rev%2012-1-2007.doc

Date added: September 25, 2011 - Views: 13

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COMMUNITY HEALTH CARE, INC - Aspirus Medical Staff

Each Specialty or MMC will present a summary of its peer review activities to the physicians of the QRC on regular basis. ... documentation will include the elements described in 8.2 accompanied by a final copy of an Initial Review form to document in greater detail resultant findings and ...

http://www.aspirusmedicalstaff.org/media/MedicalStaffPeerReviewProcess2011.doc

Date added: May 2, 2013 - Views: 22

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Referral Notification Form - ReMed Casualty Consultants, Inc.

Independent Medical Evaluation by Physician with IME Recommendations . Chiropractic Peer Review with Chiropractor’s Recommendations. ... Referral Notification Form Author: Connie Kubis Last modified by: connie Created Date:

http://remedcasualty.com/images/Referral_Notification_2009.doc

Date added: January 30, 2012 - Views: 14

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ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK

EXTERNAL PEER REVIEW NETWORK. PHYSICIAN REPORT FORM - RADIOLOGY CONFIDENTIAL. Part I – to be completed by the requesting hospital and ICAHN office and sent to the assigned peer review physician.

http://www.icahn.org/files/EPRN_Library/radiologist_eprn_report_form.doc

Date added: September 30, 2013 - Views: 1

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www.stlukesonline.org

POLICY AND PROCEDURES. FOR. BOISE/MERIDIAN POLICY TITLE: Medical Staff Peer Review Policy POLICY STATEMENT: Purpose: To ensure that the hospital, through the activities of its medical staff, assesses the Ongoing Professional Practice Evaluation of individuals granted clinical privileges and uses ...

http://www.stlukesonline.org/for_physicians/committees/documents/PeerReviewPolicy3.08.doc

Date added: September 30, 2013 - Views: 4

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MGI 44-118 Nurse Telephone Triage Advice ... - Comments on

Physician Phone Triage Consultant/Primary Care Manager (PCM): Reviews daily triage nurse documentation on those patients given advice or triaged and not given a same-day appointment. ... SF 600 Telephone Triage form. 3. Peer review for Triage

http://www.awhonn-af.org/awhonn-af/wp-content/uploads/2010/12/MGI-44-118-Nurse-Telephone-Triage-Advice-Program2.doc

Date added: March 26, 2013 - Views: 19

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Fall Prevention and Management Program - MN Hospitals

DO NOT INCLUDE THIS FORM IN THE PATIENT’S MEDICAL RECORD. SECTION A: To be completed by clinical staff Location at time of fall (ward, clinic, service, ... Forwarded for ABI Mortality & Morbidity Review Root Cause Analysis Physician Peer Review . Case closed Other (please specify)

http://www.mnhospitals.org/Portals/0/Documents/ptsafety/falls/NCPS_Fall_Incident_Report.doc

Date added: April 5, 2013 - Views: 22

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Confidential For Peer Review Purposes Only

form:_____ MR Number: ... **ALL “YES” RESULTS ARE FALLOUTS AND REQUIRE REVIEW. Physician reviewer signature ... Confidential For Peer Review Purposes Only Author: Christine Reeves Last modified by: CHS Created Date: 2/18/2011 10:47:00 PM Other titles: ...

http://www.gcrac.org/wp-content/uploads/2009/05/stroke_pi_indicators_12-09.doc

Date added: September 30, 2013 - Views: 10

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Criteria

If Advance Directive exists, but is not available, signs the Advance Directive Alert form completed by Social Services. 15. S&R ... Physician Peer Review. 1 . Attachment A. Title: Criteria Author: HHSADM_TA Last modified by: fausto.carlos Created Date: 9/28/2010 4:11:00 AM ...

http://www.sccgov.org/sites/led/appraisal/Documents/In-Patient-MH-BAP-Peer-Review_Attachment-A.doc

Date added: July 26, 2013 - Views: 1

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Fall Prevention and Management Program - MN Hospitals

Refer to the interdisciplinary treatment team to review fall prevention interventions and modify care ... (Section B. of the Fall Incident Report Form, ... No further action Investigation indicated: (check type) Physician Peer Review . Mortality & Morbidity Review. Root Cause Analysis.

http://www.mnhospitals.org/Portals/0/Documents/ptsafety/falls/NCPS_Falls_Policy.doc

Date added: March 4, 2013 - Views: 20

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Policy: Administrative - NAHQ

DO NOT PHOTOCOPY. Peer Review information is maintained . solely in the Quality & Patient Safety Office. Case #: A. PATIENT INFORMATION Patient Initials: Medical Record Number: Admission Date: Discharged: Event Date: Department(s) Involved: Involved Physician(s): PSR ...

http://www.nahq.org/uploads/appsfiles/UPDATED_GENERAL_peer_review_worksheet.doc

Date added: August 15, 2013 - Views: 7

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TRAUMA ED CHART REVIEW

Documentation may be in Medhost or other special care documents such as the conscious sedation form. ... It is prepared for the Hospital’s Peer Review and Quality Assurance Functions, ... TRAUMA ED CHART REVIEW ...

http://www.traumanurses.org/_resources/resource_library/forms/trauma_ed_nursing_chart_review.doc?phpMyAdmin=YUKhXpm3NuRfJ3YccE22H8dYHvf

Date added: May 9, 2013 - Views: 9

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PEER REVIEW - Medical Communications Corporation

PA Auto. What is a Peer Review? A Peer Review conducted under Act 6 of the Pennsylvania Automobile Reform is a review of a Health Care Professional by a reviewer of a similar or like specialty to determine the appropriateness and necessity of care rendered to a claimant (reviewer must be PA ...

http://mccime.com/medmail/Pennsylvania%20Peer%20Review.doc

Date added: October 3, 2011 - Views: 4

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A License to Harm or Good Public Policy: An Ethical Analysis ...

Title: A License to Harm or Good Public Policy: An Ethical Analysis of Medical Peer Review Immunity in Texas Author: odoml Last modified by: Camar

http://works.bepress.com/context/lamar_odom/article/1000/type/native/viewcontent/

Date added: October 3, 2011 - Views: 21

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What’s Up for New Providers - Children's Healthcare of Atlanta

Frankie King, Manager, Physician Peer Review, [email protected], 404-785-7465. ... - Discharge summary (or Short Stay Form if applicable) - Physician's orders (signed, timed and dated) - Anesthesia records. First Occurrence (within a 12 month period):

http://www.choa.org/Menus/Documents/PhysicianPortal/Med%20Staff%20Gov/Manual_FINAL%200108.doc

Date added: November 3, 2011 - Views: 63

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PARAMOUNT REVIEW SERVICES, LLC

This form is automated for editing on your desktop and can be printed & faxed or saved & emailed. ... Service Requested. Case Type. IME / RME Peer Review Auto. SLU Radiology Review Workers ’ Compensation. FCE ... Claimant Attorney Attending Physician/Provider WCB: type office here. Name and ...

http://paramountreview.com/docs/prs-ime-and-peer-request-form.doc

Date added: September 11, 2014 - Views: 1

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Hospital PRQ - American College of Surgeons

Does the trauma medical director ensure and document dissemination of information and findings form the peer review meetings to the non-core surgeons on the trauma call ... D. List a minimum of 20 physician peer review trauma-related publications the hospital's staff has published within the ...

https://www.facs.org/~/media/files/quality%20programs/trauma/prq.ashx

Date added: August 26, 2014 - Views: 1

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Drug Regimen Review Request Form

As follow-up to a Medication Review, Peer to Peer Outreach provides a telephonic meeting with the treating ... Payment is due upon receipt of the completed Review. Most reviews will be completed within 20 business days of receiving the completed request ... Drug Regimen Review Request Form

http://painmanagement.pmsionline.com/Documents/MedAssess_Care_Management_Services%20Request_Form_8-24-2012_(Locked).docx

Date added: November 21, 2013 - Views: 6

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Trauma Quality Improvement Worksheet - Minnesota Department ...

Trauma PI Tracking Form. Demographics. Date of report: Medical record #: Source of Information; ... peer review. resource enhancement. privilege/credentialing review. Action Plan: Signature: Date: Adapted from American College of Surgeons,

http://www.health.state.mn.us/traumasystem/hospresources/resourcemanual/pitrackingform.docx

Date added: May 9, 2012 - Views: 13

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Credentialing Manual for Long Term Care - Colorado Medical ...

Peer Review Letter. Initial Credentialing Decision Sheet. Individual Performance Re-appointment Review. Re-appointment Flow Sheet. ... For re-appointment, the facility will utilize an evaluation form that reviews my performance in the facility.

http://www.cmda.us/Articles/Credentialing%20Manual%20for%20Long%20Term%20Care.doc

Date added: December 16, 2011 - Views: 22

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Enter Policy # in FILE - PROPERTIES - SUMMARY - 'Title:' - TN.gov

... a medical review or physician peer review of the death may be conducted as part of the Initial Agency Death Review or at any time thereafter. ... The DIDD Regional Director or designee shall review the form for completeness and transmit it to the DIDD Commissioner or designee.

http://www.tn.gov/didd/provider_agencies/policies/Death%20Review%20Policy%205-31-2012.doc

Date added: June 20, 2013 - Views: 19

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MEDICAL STAFF BYLAWS, POLICIES, AND

4.7 Application Form 11. 4.8 Grant of Immunity and Authorization to Obtain/Release Information 11. 5. ... 6.3 Responsibilities of Supervising Physician 21. 7. PEER REVIEW PROCEDURES FOR QUESTIONS. INVOLVING ALLIED HEALTH PRACTITIONERS. 22.

https://www.sjmed.com/documents/phys/Allied%20Health%20Policy%20Oct%202010.doc

Date added: September 9, 2014 - Views: 1

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Application Guidance for Level 4 Trauma Center Designation

You may download the application for a level IV Trauma Hospital Designation from the program Web site . ... Trauma PI Tracking Form, Trauma PI Filter Tracking Worksheet. and . Trauma PI Flowchart. Trauma Diversion. ... Candid physician peer review is a valuable tool in improving patient care.

http://www.health.state.mn.us/traumasystem/hospresources/applications/applicationguidance4.docx

Date added: June 12, 2012 - Views: 21

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American Health Information Management Association

... has developed a process by which organizations providing coding education can be peer reviewed against a minimum set of standards for entry-level coding ... Health records in any available form are essential for the education of coding ... Peer Review of all Report materials; Assessment ...

http://library.ahima.org/xpedio/groups/public/documents/internalproject_coding/bok1_035490.doc

Date added: March 25, 2013 - Views: 18

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Session Review Form - Good Samaritan Hospital

Were the physician attributes designated for the series appropriate for this session? ... did a pre-activity peer review of materials take place? N/A Yes No. ... Session Review Form, Page-1. Title: Session Review Form Author: Judy Hyle Last modified by: library

https://goodsam.org/classes/rss/RSS-Session-Review-Form.doc

Date added: August 8, 2014 - Views: 4

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Peer Evaluation Form for Pre-Tenure/Promotion Review

Peer Evaluation Form for Mid-Cycle Review. School of Medicine. Name of Candidate: _____ Date: _____ Mid-Cycle Review for:

https://www.ttuhsc.edu/som/facultydevelopment/documents/mid-cycle-review/PeerEvaluationForm.doc

Date added: October 30, 2011 - Views: 19

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GEORGIA REGIONAL HOSPITAL AT AUGUSTA - East Central Regional ...

Decision by the Physician Advisor will be documented on the extended stay section of the review form. Review every ten days thereafter will be required. ... The Physician Advisor acts as a peer review specialist for any case referred to him or her during the review function.

http://www.ecrh.dhr.state.ga.us/Manuals/UMPLAN.doc

Date added: May 20, 2013 - Views: 2

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October 21, 2009 - HCPro

Confidential Peer Review Document (Iowa Code Section 147.135) Medical Staff Office. Physician Reference/Evaluation Form. The following is being submitted in response to your request for information on the applicant named below.

http://blogs.hcpro.com/credentialing/wp-content/uploads/2010/04/Sample-Exit-Reference.doc

Date added: February 15, 2014 - Views: 5

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PHYSICIANS’ ACCREDITATION PROGRAM - Colorado

Level II physicians can act as treating physicians and/or they can join peer review panels in the system (IME program, ... The form will be sent to you with instructions on how to proceed. The cost for the Level I accreditation course and exam is $200.00.

http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fmsword&blobkey=id&blobtable=MungoBlobs&blobwhere=1251616377838&ssbinary=true

Date added: April 15, 2013 - Views: 8

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DRAFT TEMPLATE FOR PROGRESS REPORTS ON FACULTY SCHOLARSHIP

Publication of original research in a peer-reviewed journal. The RRC-IM defines a peer-review publication as a journal indexed in Pub Med (or MEDLINE). For publications not listed by either indexing service, ...

http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/Faculty_Scholarly_Participation_and_Productivity_Form%20(1).doc

Date added: December 17, 2012 - Views: 19

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CME Application Form - Legacy Health

from peer-reviewed journals, government sources ... Peer Review / Direct Observation Patient Feedback Physician/Patient Surveys and Evaluation Follow-up survey/interview/focus group about actual change in practice ... CME Application Form Author: Legacy Health Last modified by:

http://www.legacyhealth.org/~/media/Files/PDF/Health%20Professionals/CME%20Planning%20Resources/CME%20Planning%20Resources/Application%20Form.ashx

Date added: October 24, 2013 - Views: 14

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CodingCompliancePlan - Indian Health Service

Thoroughly review the entire health record as part of ... include the discharge summary, history and physical, emergency room record, physician progress notes, PCC encounter form, physician orders ... The query form will be retained in a separate file and use by peer review organizations will ...

http://www.ihs.gov/HIM/documents/CodingCompliancePlan.doc

Date added: October 24, 2011 - Views: 170

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Heritage Provider Network, Inc - NAHQ

Uses a peer-review process to make decisions in a ... Please refer to the to the Board Certification Exception Form that outlines the ... “blinded” records or a model medical record instead of an actual record will be reviewed. The review of medical recordkeeping practices ...

http://www.nahq.org/uploads/apps/files/Credentialing%20Program%202009%2012%2023%2008.doc

Date added: August 13, 2013 - Views: 1

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Cancellation Policy - NAMSS Home

1:00-3:00Peer Review Panel – What Do Icebergs and Physician Peer Review Have in Common? – Jon Moses, MHA, President and CEO, NorthGauge Healthcare Advisors; Kate Conklin, VP of Quality, Denton Regional Medical Center; Ellen Caiati, MD, CPHP, Linda Siderius, JD, Attorney for Caplan & Earnest, LLC

http://www.namss.org/Portals/0/StateAssociations/Colorado/2014%20CAMSS%20Fall%20Registration%20Brochure.docx

Date added: August 29, 2014 - Views: 1

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CHARLES COLE MEMORIAL HOSPITAL - Medkinetics LLC

CHARLES COLE MEMORIAL HOSPITAL. MEDICAL STAFF. RULES AND REGULATIONS. Effective Date: August 11, 1983. Revisions: Reviews:

https://reportal.medkinetics.com/peerforms/charlescole/medicalstaffrulesandregs.doc

Date added: September 11, 2014 - Views: 1

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A Guide for and Documentation of the Planning of a CME Activity

This form collects information needed to plan and develop a CME activity that improves patient care and meets accreditation requirements. Completed forms and attachments are required six months before the proposed activity date.

http://www.ucdmc.ucdavis.edu/cme/forms/CME_Planning_Form_rev_Apr16_2012_FINAL1.doc

Date added: May 5, 2013 - Views: 2

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www.imedecs.com

Thank you for choosing IMEDECS as your source for quality, comprehensive medical case review services. Please complete this form and fax it back to us at (215) 855-5318. ... journal articles/peer-reviewed literature, manufacturer’s materials, relevant medical records and plan language ...

http://www.imedecs.com/assets/Servicerequest_form_DOL.doc

Date added: September 30, 2013 - Views: 1