Evaluation (Completion of this form is mandatory)
Last Name________________________________________ First Name_________________________________ MI____________ State________________________ License #_______________________________________ Expiration Date_________________ To receive continuing education credit, completion of this Evaluation is mandatory. Please answer all of the following questions and provide your signature at the bottom of this page. Please read the following questions and choose the most appropriate answer for each course completed. # Question DCA02IF
DCA02CA The California Dental
DCA02OP Responsibilities and Requirements of Prescribing Schedule II Opioid Drugs 2 CE Hours
DCA05DE Dental Ethics and the Digital Age, 3rd Edition 5 CE Hours
Infection Control for Dental Professionals: The California Requirement 2 CE Hours
Practice Act 2 CE Hours
1 Was the course content new or review?
New Review
New Review
New Review
New Review
How many self-assessment questions did you answer correctly? How much time did you spend on this activity, including the questions? Would you recommend this course to your peers? Did the course content support the stated course objective? Did the course content demonstrate the author’s knowledge of the subject? Was the course content free of bias? Before completing the course, did you identify the necessity for education on the topic to improve your professional practice? Have you achieved all of the stated learning objectives of this course?
2
3
_______ Hours
_______ Hours
_______ Hours
_______ Hours
4
Yes No
Yes No
Yes No
Yes No
5
Yes No
Yes No
Yes No
Yes No
6
Yes No
Yes No
Yes No
Yes No
7 8
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
9
Yes No
Yes No
Yes No
Yes No
10 Has what you think or feel about this topic changed? 11 Were self-assessment questions with evaluation an effective teaching strategy? 12 Did evidence-based practice recommendations assist in determining the validity or relevance of the information? 13 Are you more confident in your ability to pro - vide patient care after completing this course? 14 Do you plan to make changes in your practice as a result of this course content?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
N/A
N/A
Yes No
N/A
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Additional Comments / Criticisms / Concerns _______________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ I have read the course(s) and completed the Evaluation(s) in full. Signature _________________________________________________________________________________________________________________ Signature required to receive continuing education credit
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