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Commitment to Change Statement
First Name
Last Name
Email
Date
Provider Number
As a result of attending this CME activity, what new strategies/abilities have you developed to make a practice change?
What can/will you do to incorporate/implement this new strategy/ability to change your practice?
Credit Attestation I claim _____ AMA PRA Category 1 Credit™ for participating as a learner in this activity - not to exceed 1.0 credits . I attest that the number of CME credits claimed above is accurate.
Your Signature
Clear
Date
I declare that the info I’ve provided is accurate & complete
Submit
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