LEARNER RECORDS: ANSWER SHEET
F
D
O
E
J
O
H
N
1
2
3
C
H
E
R
R Y
S
T R
E
E
T
D
C
4
5
6
W A S H I N G T O N
4
8
0
4
5
6
8 7 9
0
2 0 0 0 2
M D 1 2 3 4 5 6
J
O
H
N
D
O
E
@
E
M
A
I
L
.
C
O
M
A
B
I
M
1
2
3 5
4 6
D M 1
2
2
1
1 8
9 0
LICENSE NUMBER FORMATS:
PA: PA and 2-6 digits Example: PA123456
MD: MD and 4-6 digits Example: MD123456
DO: DO and 5-6 digits Example: DO123456
DATA REPORTING: Federal, State, and Regulatory Agencies require disclosure of data reporting to all course participants. InforMed abides by each entity’s requirements for data reporting to attest compliance on your behalf. Reported data is governed by each entity’s confidentiality policy. To report compliance on your behalf, it’s mandatory that you must achieve a passing score and accurately fill out the learner information, activity and program evaluation, and the 90-day follow up survey. Failure to accurately provide this information may result in your data being non- reportable and subject to actions by these entities.
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