Managed Care - March 2008 - (Page M28) CONTINUING EDUCATION ANSWER SHEET/EVALUATION/CERTIFICATE REQUEST Mind Your Body: The Intersection of Physical and Behavioral Health CE Credit for Physicians/Pharmacists Sponsored by The Chatham Institute I certify that I have completed this educational activity and post-test and claim (please check one): I Physician credit hours I Pharmacist contact hours Signature: PLEASE PRINT CLEARLY Credit will be awarded upon successful completion of assessment questions (70 percent or better) and completion of program evaluation. If a score of 70 percent or better is not achieved, no credit will be awarded and the registrant will be notified. The cost of this activity is provided at no charge through an educational grant from AstraZeneca Pharmaceuticals LP. EXAMINATION: Place an X through the box of the letter that represents the best answer to each question on page 27. There is only ONE correct answer per question. Place all answers on this form: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. A. I I I I I I I I I I I I B. I I I I I I I I I I I I C. I I I I I I I I I I I I D. I I I I I I I I I I I E. I Was this publication fair, balanced, and free of commercial bias? I Yes I No If no, please explain: Please use the following scale to answer the next four questions: Strongly Agree 5 Agree 4 Neutral 3 Disagree 2 Strongly Disagree 1 Did this educational activity meet my needs, contribute to my personal effectiveness, and improve my ability to: Treat/manage patients? 5 4 3 2 1 N/A N/A N/A First name, MI Last name, degree Title Affiliation Mailing address City State ZIP Daytime telephone ( ) Fax ( ) E-mail Physician — This activity is designated for a maximum of 2.75 AMA PRA Category 1 Credit(s). TM Pharmacist — This activity is approved for 2.75 contact hours (0.275 CEU). ACPE Universal Program Number (UPN): 812-000-08-007-H01-P Release date: Mar. 15, 2008 Expiration date: Mar. 1, 2009 To receive credit, complete the answer sheet/evaluation form and mail or fax the completed form to: The Chatham Institute 26 Main Street, 3rd Floor Chatham, NJ 07928-2402 Fax: (800) 239-2984 Allow up to 6 to 8 weeks for processing. T7Z06-MG Communicate with patients? 5 4 3 2 1 I I Manage my medical practice? 5 4 3 2 1 Other 5 4 3 2 1 N/A Effectiveness of this method of presentation: Excellent Very good Good Fair Poor PROGRAM EVALUATION So that we may assess the value of this self-study program, we ask that you please fill out this evaluation form. Have the activity’s objectives been met? 1. Discuss the link between physical health and behavioral health and the impact on appropriate patient care management. I Yes I No 2. Identify opportunities for health plans and practitioners to collaborate to reduce emergency care services and hospitalizations, and to ensure the appropriate use of diagnostic tests, ambulatory care, and psychotropic medications. I Yes I No 3. Identify solutions to some of the key challenges facing medical directors, pharmacy directors, and other health care professionals. I Yes I No 5 4 3 2 1 What other topics would you like to see addressed? Comments: 28 MANAGED CARE / SUPPLEMENT
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