Tools for Chapters and Other Organizations Jointly Sponsoring a CME Event With ATS

TABLE OF CONTENTS

All files are in MS Word format unless otherwise noted.

Part I. Application Attachments

About Tools for Chapters

1. Sample Documentation of CME Committee Planning
   • Model Minutes of a local CME Committee
   • CME Activity Work Up Sheet
   • Model letter from head of Planning Committee to ATS
   • Teaching by Design Form
2. Evaluation
   • A Simple and Basic Evaluation Form
3. Planning Committee Disclosure Forms
   • Individual Disclosure
   • Summary of Mutual Disclosure
   • Supplemental CME Planning Committee Roster Form
4. Communication with Faculty
   • Sample Faculty Invitation Letter
   • Sample Faculty Action Information Sheet
   • Individual Faculty Disclosure
   • Summary of Faculty Disclosures
   • Agenda Faculty and Topic Objective Worksheet
   • Individual Faculty Off Label Collection Instrument
5. Brochure
   • A Brochure Check List
6. Conflict of Interest Resolution
   • New COI Policy (effective 3/2008)
   • Supplemental Local COI Disclosure and Management Form
7. Grant Requests and Budgets
   • ATS Honorarium Policy

Part II. Post Activity Report

1. Capturing Attendance
   • Post Activity Assignment Review
   • Sample Physician Sign-in Sheet
   • Sample Non-Physician Sign in Sheet
2. Awarding CME Credits to Learners and Recognizing Other Health Professionals for Attendance
   • An Excel Spreadsheet Template (MD/DO only)
   • A Certificate of CME Award
   • A Certificate of Attendance
3. Evaluating Knowledge, Competence, Performance in Practice and Patient Outcomes
   • Sample Evaluation Summary for Staff New to CME Evaluation
   • Sample Vignettes
4. Assuring Disclosure to the Learner at the Event
   • Attestation of Oral COI Disclosure to the Audience
   • Documentation of Written Faculty Disclosure Disseminated at Event
5. Reporting for ACCME, AMA, FDA, and Event Supporters
   • Required ATS Letter of Transmittal