Forms 2017-08-31T16:12:24+00:00

The following forms are available to assist in the planning process. Guidance on completion and time frames for submission are available by contacting Terri Neaderhiser, CME Program Administrator, at 317-692-5222, ext. 283 or by email at cme@suburbanhealth.com.

• Intake Form   (Docx)  (PDF)
• Disclosure of Relevant Financial Relationships Form  (Docx)  (PDF)
• Attendance List  (XLSX)
• Content Outline  (Docx)  (PDF)
• Attendance Template (Requires planners to check-in participants to confirm attendance.)  (Excel)
• Sign-in Sheet (Requires participants to sign-in to confirm attendance.)  (Docx)

The following forms will be developed in collaboration with or provided by SHO’s CME team.

• Application and Planning Worksheet
• Save the Date
• Promotional Flyer
• Faculty Agreement
• Commercial Support Agreement
• Exhibitor or Educational Grant Agreement
• Disclosure Grid
• Disclosure Attestation
• Evaluation Form
• Outcomes Assessment
• Participant Verification Form
• Certificates, if requested (SHO tracks participation in the CME Web Tracker database. Online transcripts are available to participants.)
• Other forms, as needed