General Information of the Participant
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| Last Name: |
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| First Name: |
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| Mail Address: |
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| Contact Phone: |
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| Email: |
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Activity and Dates
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the activity and 3 probable dates to participate in each
activity |
| Example
Activity : Emergency Room Clinical Exercise (ERCE) |
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Dates: (1)5/29 (2)5/19 (3)5/20 |
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Activities
and Sessions
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Emergency Room Clinical Exercise:
Only for Primary Physicians requesting CME as requisite of
the PR Board of Examiners (TEM).
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Dates: (1)
(2)
(3)
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Available
Dates for Emergency Room Clinical Exercises -
Beginning July 2009 (Please select three of the
following dates in the order of your preference and write
them down in the spaces available above).
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Month |
Day |
Hour |
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July |
Saturday, 11 |
8:30 AM |
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August |
Saturday, 1 |
8:30 AM |
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Saturday, 22 |
8:30 AM |
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September |
Saturday, 19 |
8:30 AM |
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October |
Saturday, 10 |
8:30 AM |
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Saturday, 24 |
8:30 AM |
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November |
Tuesday, 7 |
8:30 AM |
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Wednesday, 14 |
8:30 AM |
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December |
Saturday, 5 |
8:30 AM |
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Saturday, 12 |
8:30 AM |
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Residency
Programs Clinical Exercise: Only for physician in training
to complete a Residency Program.
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Emergency Room |
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Dates: (1)
(2)
(3) |
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Family Medicine |
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Dates: (1)
(2)
(3) |
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Obstetric & Gynecology |
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Dates: (1)
(2)
(3) |
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Sessions:
S#1
S#2
S#3(CA) |
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Internal Medicine |
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Dates: (1)
(2)
(3) |
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Sessions:
S#1
S#2
S#3(CA) |
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Pediatrics |
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Dates: (1)
(2)
(3) |
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Sessions:
S#1
S#2
S#3(CA) |
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Transitional Internship |
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Dates: (1)
(2)
(3) |
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Sessions:
S#1
S#2
S#3(CA) |
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Practice Exercise for the Clinical Skills Exam |
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Dates: (1)
(2)
(3) |
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