CPER - CME Request Form

CME Credit Request Form

Name(*)

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Email(*)

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Phone Number(*)

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Self-Directed CME Activity/Education(*)

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Hours spent on CME Activity

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Number of CME credits requested

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Education Date(s)

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Course Location/Contact Person(*)

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What are the clinical components of this education?

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What new knowledge will you gain from this education?

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What are the procedural skills you will learn or practice with this education? Focus attention to dealing with low-frequency, high-acuity situations where applicable.

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The general test for CME credit allocation is – "Does the educational activity enhance the clinical practice of paramedicine at the certification level of the paramedic?"

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