continuing education NAMSS CE Quiz: Mobile Devices and Their Use In Healthcare Instructions: Make a photocopy of this form – DO NOT REMOVE THE PAGE from the magazine so that others also may use it to obtain CE credit . Print your name and address in the form below . This form will be mailed back to you to use as your CE credit certificate . DEADLINE TO SUBMIT YOUR QUIZ FOR CREDIT IS FEBRUARY 1, 2014 . Take this quiz online and receive your results immediately! Click the SYNERGY Quizzes link in the Headlines section of www.namss.org. Name: Facility: Address: City/State/ZIP: Title: Business Phone: Signature: Date: Answers Place an “X” in the box next to the correct answer . True/False and Multiple Choice 1 . a . ❑ b . ❑ c . ❑ c . ❑ 2 . a . ❑ b . ❑ c . ❑ c . ❑ 3 . a . ❑ b . ❑ c . ❑ c . ❑ 4 . a . ❑ b . ❑ c . ❑ c . ❑ 5 . a . ❑ b . ❑ c . ❑ c . ❑ 6 . a . ❑ b . ❑ 7 . a . ❑ b . ❑ 8 . a . ❑ b . ❑ 9 . a . ❑ b . ❑ 10 . a . ❑ b . ❑ Payment Information ❑ Processing Fee: $15 members OR $25 non-members ❑ Check Payment: Enclosed is a check or money order payable to NAMSS (DO NOT SEND CASH) . Check No .: Date: Amount: $ Check one: ❑ Facility Check ❑ Credit Card Payment: Check one: ❑ MC ❑ Visa ❑ Personal Check ❑ AMEX ❑ Discover I authorize NAMSS to charge my credit card $ Credit Card No .: Exp . Date: Cardholder’s Name (PLEASE PRINT): Facility (IF APPLICABLE): Cardholder’s Address: City/State/ZIP: For NAMSS Executive Office Use Only Cardholder’s Phone: Score: Authorized Signature: ❑ You have passed this quiz and earned one (1) Category I CE clock hour . I understand my billing statement will read “NAMSS.” ❑ You scored below 80% and DO NOT earn CE credit . A charge of $25 will apply for all non-sufficient fund checks . NOTE: No record will be kept at NAMSS of this quiz . Keep this form as evidence of completion . 30 / SYNERGY January/Febr uary 2013 If rebilling a credit card is necessary, a $25 processing fee will be charged . Mail To: NAMSS Attention CE Department 2025 M Street, NW, #800 Washington, DC 20036http://www.namss.org