Please complete this joint providership application as the initial step in evaluating the viability of this initiative. The Continuing Medical Education (CME) staff will follow up within ten business days to provide further instructions.

The following minimum lead times are required for submission:

- Three months in advance of a live, webinar, or hybrid activity up to two hours in duration.

- Six months before an instructional design online activity.

- Twelve to eighteen months before a symposium.

All submissions must meet the American Medical Association (AMA) definition of CME content, which is education designed to maintain, develop, or enhance the knowledge, skills, professional performance, and relationships necessary for physicians to provide services to patients, the public, or the profession. This CME content includes the body of knowledge and skills that are widely recognized and accepted by the medical profession within the basic medical sciences, the discipline of clinical medicine, and the delivery of healthcare to the public. Applications that do not conform to this definition will be denied.

Please note that the submission of this form does not guarantee approval.

Fees: Joint providership application fee: $750 per CME/CE activity requested. Additional compliance management fees will apply based on the required services including compliance and planning management fees and a CME/CE processing fee per approved hour/s. 

Payment: An invoice will be issued, and prompt payment will be required to proceed with the planning process.

Thank you for your attention to these guidelines.

 

Activity Details

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Educational Needs

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State the educational opportunity or the difference between current practice and best practice on which this activity was based.
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Knowledge need (i.e., is there new technology or new information that physicians need to know more about) Competence need (i.e., are there tools or strategies available that might help learners apply what they should already know) Performance need (i.e. is there new technology or clinical information that necessitate learners assimilating new skills)

Designed to Change

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Provide evidence-based references (peer-reviewed journal articles links) that highlight the educational need (practice gap) and support the desired goal (what the activity is designed to change).

Activity Formats

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Competencies

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Planners/Faculty Info

  • Each planner/faculty must complete this disclosure form (click to link)
  • Communicate disclosure information collected to learners in a tangible way in advance of the activity (e.g., on the flyer, in the Final Program, or with some other written documentation). Baptist Health CME must retain a copy of this evidence.
  • Planners and faculty listed on this log who identify relevant relationships with ineligible companies will trigger the Baptist Health CME's resolution of conflict of interest (COI) process.

Commercial Support

Commercial support is financial or in-kind (e.g. products) contributions given by an ineligible company (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients) which is used to pay all or part of the costs of a CME activity.

This does not include fees paid by vendors for an exhibit booth or companies that pay corporate sponsorships in exchange for ads, booth space, or other tangible benefits.

All applicants pursuing commercial support must abide by the Standards for Integrity and Independence in Accredited Continuing Education. A copy of all letters of agreement with ineligible companies is required for Baptist Health compliance files.

A compliance fee will be charged to all applicants seeking commercial support.

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Please check each attestation

Exhibitor and Corporate Support    

Standard 2 of the Standards for Integrity and Independence in Accredited Continuing Education specifies that accredited continuing education must protect learners from commercial bias and marketing.
1. The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.
2. Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.
3. The accredited provider must not share the names or contact information of learners with any ineligible company (any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients) or its agents without the explicit consent of the individual learner.

A compliance fee will be charged to all applicants seeking exhibitors or corporate support.

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How will you determine the effectiveness of your CME activity?

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All applicants requiring Baptist Health CME support services with the activity evaluation will incur an additional fee.
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I hereby certify that the information provided in this application is complete and accurate to the best of my knowledge. In the event any information changes or the CME Activity descriptions are no longer accurate, I agree to notify Baptist Health CME at [email protected]. In addition, I agree that our organization will fulfill the expectations and obligations as set forth by Baptist Health CME, including the submission of requested compliance documentation and payment of all fees within the time frames specified and understanding that the failure to do so can result in the assessment of a late fee or termination of services.
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Please type your First and Last Name
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