Evaluation (Completion of this form is mandatory)
MDRI2026
Last Name ____________________________________________ First Name _ ___________________________________ MI _ _____ State ____________________________ License # _______________________________________ Expiration Date _ _____________
To receive continuing education credit, completion of this Evaluation is mandatory.
Please read the following questions and choose the most appropriate answer for each course completed. 1. Was the course content new or review? 2. How much time did you spend on this activity, including the questions? (Physicians should only claim credit commensurate with the extent of their participation in the activity.) 3. Would you recommend this course to your peers? 4. Did the course content support the stated course objective? 5. Did the course content demonstrate the author’s knowledge of the subject? 6. Was the course content free of bias? 7. Before completing this course, did you identify the necessity for education on the topic to improve your professional practice? 8. Have you achieved all of the stated learning objectives of this course? 9. Has what you think or feel about this topic changed? 10. Did evidence-based practice recommendations assist in determining the validity or relevance of the information? 11. Are you more confident in your ability to provide patient care after completing this course? 12. Do you plan to make changes in your practice as a result of this course content? 13. May we contact you later regarding planned changes in your practice and changes in treatment or health status of your patients as a result of this activity?
1. New Review 2. _____ Hours 3. Yes MDRI03AD 3 Credits
1. New Review 2. _____ Hours 3. Yes MDRI10OD 10 Credits
1. New Review 2. _____ Hours 3. Yes MDRI02FD 2 Credits
1. New Review 2. _____ Hours 3. Yes MDRI05MM 5 Credits
No No No No No No No No No No No
No No No No No No No No No No No
No No No No No No No No No No No
No No No No No No No No No No No
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes 12. Yes 13. Yes
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes 12. Yes 13. Yes
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes 12. Yes 13. Yes
4. Yes 5. Yes 6. Yes 7. Yes 8. Yes 9. Yes 10. Yes 11. Yes 12. Yes 13. Yes
MDRI03AD - Alzheimer’s Disease and Dementias: Insights for Early Detection and Care Planning — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? __________________________________________ ________________________________________________________________________________________________________________ MDRI10OD - Opioid Use Disorder — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________________________________________________ ________________________________________________________________________________________________________________ MDRI02FD - Frontotemporal Dementia — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _________________________________________________________________________________________ ________________________________________________________________________________________________________________ MDRI05MM - Medical Marijuana and Other Cannabinoids — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _______________________________________________________________________ ________________________________________________________________________________________________________________ Signature _________________________________________________________________________________
Signature required to receive continuing education credit.
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MDRI2026
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