Elective CME Pre-Approval Request

Elective CME Pre-Approval Form

Ensure to enter your EHS# at the bottom of the form.
You may attach a file below to help support your request.

Title of CME Event(*)

Please enter paramedic's name.

Date of CME Event(*)

Please enter a valid date.

CME Hours Requested

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Education Methods

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Is the CME focused on low frequency, high acuity skills as a paramedic?

YES NO Invalid Input

What is the clinical value of this elective CME?(*)

Please provide the detail of your request.

What new knowledge will you gain?(*)

Please provide the detail of your request.

Please provide details

Please provide the detail of your request.

Have you participated in the same activity for CME in the past?

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how many years ago?

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Attach file

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EHSN

EHSN is a five digits number.

Name of person submitting(*)

Please enter your full name.

Email(*)

Please enter a valid email address.