ITPeducation.com™ CME-Webinar - Attestation/Evaluation Form

Managing Thrombocytopenia in Patients with Chronic Liver Disease

Complete and submit this form to apply for AMA PRA Category 1 Credit™. Upon acceptance of this form by The France Foundation, you will receive a certificate documenting your successful completion of this activity. Please note that this entire form must be completed to receive credit.

Participant Information:

First Name:*

Last Name:*

Please Indicate Your Degree(s):*

Address:*

City:*

State/Province:*

ZIP/Postal Code:*

Email address:*

Clinician Type:*

If Other:

Number of years in practice:*

What percent of your patients are at risk for ITP?:*

Indicate the number of Credits you are claiming:
(May not exceed 0.5 credit)*

Bias, Fair Balance:

Was this activity fair, balanced, objective, and free from commercial bias?

If no, please state reason(s)

Barriers:

What are the top 3 barriers you feel might inhibit your ability to incorporate any of the above changes into your clinical practice?

Met Learning Objectives:

4-Strongly Agree 3-Agree 2-Disagree 1-Strongly Disagree

Upon completion of this activity, I will be able to:

Describe the latest clinical evidence on the use of therapies stimulating platelet production in other patient populations prone to thrombocytopenia, including chronic liver disease and cancer patients

How Did You Come to Participate in this CME Activity?

ITPeducation.com^™ CME Activity Participation

Prior to this activity, what is the approximate number of ITPeducation.com^™ CME activities that you have participated in this calendar year?

After participating in this activity, how likely are you to participate in an ITPeducation.com^™ CME activity in the future?