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Movement Disorders Review CME Certificate
Full Name, Degree (Example: John Smith, MD)
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City, ST (Example: Detroit, MI)
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Enter your email address for CME/CE certificate delivery.
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Enter today's date.
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+
Please choose the best answer for each of the following.
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Strongly Agree
Agree
Disagree
Strongly Disagree
The information presented WAS NOT biased or compromised by commercial support.
Strongly Agree
Agree
Disagree
Strongly Disagree
This activity met its learning objectives.
Strongly Agree
Agree
Disagree
Strongly Disagree
This activity provided new information to you.
Strongly Agree
Agree
Disagree
Strongly Disagree
The educational approach was conducive to your learning experience.
Strongly Agree
Agree
Disagree
Strongly Disagree
The information presented is applicable to your clinical practice.
Strongly Agree
Agree
Disagree
Strongly Disagree
The information presented will help you improve patient outcomes.
Strongly Agree
Agree
Disagree
Strongly Disagree
This activity increased my kowledge, competence, and/or will improve my performance in my practice.
Strongly Agree
Agree
Disagree
Strongly Disagree
I intend to implement changes in my practice based on the information presented.
Strongly Agree
Agree
Disagree
Strongly Disagree
If you plan to implement changes in your practice, check ALL the changes you plan to apply.
Differentiate and diagnose movement disorders.
Treat and management movement disorders.
Utilize surgical, deep brain stimulations, or injection options on a case-by-case basis.
Manage non-motor features of movement disorders.
Are there any barriers that would keep you from implementing the practice paradigms discussed in this activity?
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No perceived barriers.
Lack of evidence-based guidelines.
Lack of applicability of guidelines to my current practice and/or patients.
Lack of time.
Organizational/Institutional.
Insurance/Financial.
Patient Adherence/Compliance.
Treatment related adverse events.
Of the patients you will see in the next week, about how many will benefit from the information you learned by participating in this activity?
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1-10
11-25
26-50
>50
How do you rate Dr. Dashtipour's delivery of this education?
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Excellent
Very Good
Average
Needs Improvement
How do you rate Dr. Espay's delivery of this education?
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Excellent
Very Good
Average
Needs Improvement
How do you rate Dr. Tagliati's delivery of this education?
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Excellent
Very Good
Average
Needs Improvement
Claim Credit
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I certify that I have participated in the number of hours (0.25 increments, up to 6 hours chosen below) of this educational activity and request a CME certificate indicating that number of credits. I will claim only the total number of hours for which I participated.
The number hours you participated in this activity (0.25 increments, up to 6 hours).
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6.0
5.75
5.5
5.25
5.0
4.75
4.5
4.25
4.0
3.75
3.5
3.25
3.0
2.75
2.5
2.25
2.0
1.75
1.5
1.25
1.0
0.75
0.5
0.25
What is your specialty (Ex. Family Practice, Neurology, etc)
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How many years have you been in practice?
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<10
10-20
21-30
>30
How many days a week do you see patients?
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0-1
2-3
4-5
6-7
How many patients do you typically see per day?
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0-10
11-20
21-30
31-40
>40
What is your practice like?
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Solo or small group (1-5 providers)
Large Group (>5 providers)
Government Owned Facility/Clinic
Retired/Not Seeing Patients
Other (please specify)
Other (please specify)
Overall comments on this activity.
Patient Mind, Inc. ● 11937 W. 119th Street, Suite 216, Overland Park, KS 66213 ● patientmind.org