VTEeducation.com™ CME-Webinar - Attestation/Evaluation Form

Falling Through the Cracks: Why Hospitalized Patients Do Not Receive Appropriate Thromboprophylaxis

Complete and submit this form to apply for up to 0.5 AMA PRA Category 1 Credit™. Upon acceptance of this form by The France Foundation, you will receive a certificate documenting your successful completion of this activity. Please note that this entire form must be completed to receive credit.

Participant Information:

First Name:*

Last Name:*

Please Indicate Your Degree(s):*

Address:*

City:*

State/Province:*

ZIP/Postal Code:*

Email address:*

Clinician Type:*

If Other:

Number of years in practice:*

What percent of your patients are at risk for VTE?:*

Indicate the number of Credits you are claiming:
(May not exceed 0.5 credit)*

Bias, Fair Balance:

Was this activity fair, balanced, objective,
and free from commercial bias?

If no, please state reason(s)

Practical Application:

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree

What I learned in this activity has increased my confidence regarding the appropriate use of pharmacotherapies in the management of patients with venous thromboembolism (VTE).

What I learned in this activity will improve my ability to assess and manage venous thromboembolism in my patients

What I learned in this activity will result in an improvement in my patients' health.

Do you intend to make changes or apply new information to your practice as a result of this activity?

*If yes or you are considering changes, please check off what you intend to do differently or incorporate into your clinical practice as a result of this educational activity

please list

Barriers:

What are the top 3 barriers you feel might inhibit your ability to incorporate any of the above changes into your clinical practice?

Met Learning Objectives:

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree

Upon completion of this activity, I will be able to:

List the risk factors for VTE and assess overall risk in each hospitalized patient.

Demonstrate awareness of the most recent guidelines for risk assessment and prophylaxis in VTE and identify potential gaps in relation to current practice.

Develop a strategy for improving guideline adherence and reducing thromboembolic risk within the hospital setting.

How Did You Come to Participate in this CME Activity?

VTEeducation.com^™ CME Activity Participation

Prior to this activity, what is the approximate number of VTEeducation.com^™ CME activities that you have participated in this calendar year?

After participating in this activity, how likely are you to participate in an VTEeducation.com^™ CME activity in the future?