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- ACCREDITATION PROFORMA FOR CME/CDE ACTIVITY.
- Name of the
Institution/Organization:_____________________________________________
- Postal address of the
Institution/Organization:_______________________________________
- Name of Focal
Person:_______________________ Designation:________________________
- Focal Person Mob: No:_______________________
Email address:______________________
- Expected Number of participants
attending CME/CDE activity:_________________________
- Date,
Time, Duration & Venue of the Program.
- a. Date:________________ b.
Time:______________________ c.
Days:_________________
- d. Hours:_______________ e.
Venue:_____________________________________________
- Nature of program offered
(CME/CDE OR both):___________________________________
- Program specified for GPs/PGs/Specialists/Faculty:__________________________________
- Title of Workshop/Symposium (to
be appear in certificates):___________________________
- Topic Theme of
Workshop/Symposium:___________________________________________
- Total Number of Credit Hours/Claimed:___________________________________________
- Documents
to be attached:
- b. Registration Fee Receipt
- Note: Feedback from participants is mandatory
for issue of certificates. Signature
with Stamp.