Elite Learning
Evaluation (Completion of this form is mandatory)
DCA2525
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 test questions? 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?
The California Dental Practice Act (Mandatory) 2 CE Credit Hrs
Infection Control for Dental Professionals: The California
Responsibilities and Requirements of Prescribing Schedule II Opioid Drugs (Mandatory) 2 CE Credit Hrs
Caries-Prone Patients: Prevention, Assessment, and Intervention 4 CE Credit Hrs
Healthcare- Associated Infections 15 CE Credit Hrs
Requirement (Mandatory) 2 CE Credit Hrs
1. New
1. New
1. New
1. New
1. New
Review 2. _____ Hours
Review 2. _____ Hours
Review 2. _____ Hours
Review 2. _____ Hours
Review 2. _____ Hours
3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. N/A 11. Yes No 12. Yes No
3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. N/A 11. Yes No 12. Yes No
3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. N/A 11. Yes No 12. Yes No
3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. Yes No 11. Yes No 12. Yes No
3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. Yes No 11. Yes No 12. Yes No
The California Dental Practice Act — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ___________________________________________________________________________________________ Infection Control for Dental Professionals: The California Requirement — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? ________________________________________________________________ Caries-Prone Patients: Prevention, Assessment, and Intervention — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _______________________________________________________________________ Healthcare-Associated Infections — If you answered YES to question #12, how specifically will this activity enhance your role as a member of the interdisciplinary team? _ _____________________________________________________________________________________________ Responsibilities and Requirements of Prescribing Schedule II Opioid Drugs — 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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