2 3 4 5 6 7 8 9 10 11 12 13 14 15 Section B—Documentation of CME Planning Requirements Target Audience For which disciplines will this activity be planned (target audience) [NOTE: for each discipline selected below, there should be a corresponding planning committee member from that discipline]: Physicians Nurses Nurse practitioners Pharmacists Pharmacy Techs Physician assistants Optometrists Other (specify): If this activity is being planned for two or more disciplines, how will the various scopes of practices be addressed in the content of this activity: Targeted Medical Specialties [check all that apply]: Allergy & Immunology Internal Medicine Anesthesia Neonatology Cardiology Nephrology Critical Care Neurology Dermatology Neurosurgery Emergency Medicine Nuclear Medicine Endocrinology Obstetrics Gastroenterology Oncology Gerontology Ophthalmology Gynecology Orthopaedics Gynecologic Oncology Orthopaedic Surgery Hematology Otolaryngology Infectious Disease Pathology
2 3 4 5 6 7 8 9 10 11 12 13 14 15 Section B—Documentation of CME Planning Requirements Target Audience For which disciplines will this activity be planned (target audience) [NOTE: for each discipline selected below, there should be a corresponding planning committee member from that discipline]: Physicians Nurses Nurse practitioners Pharmacists Pharmacy Techs Physician assistants Optometrists Other (specify): If this activity is being planned for two or more disciplines, how will the various scopes of practices be addressed in the content of this activity: Targeted Medical Specialties [check all that apply]: Allergy & Immunology Anesthesia Cardiology Critical Care Dermatology Emergency Medicine Endocrinology Gastroenterology Gerontology Gynecology Gynecologic Oncology Hematology Infectious Disease Internal Medicine Neonatology Nephrology Neurology Neurosurgery Nuclear Medicine Obstetrics Oncology Ophthalmology Orthopaedics Orthopaedic Surgery Otolaryngology Pathology
cme-application-and-planning-document-09.2018.docx