Small Group QI Project (1-10) Physicians

Instructions

DO NOT COMPLETE THIS APPLICATION, IF...

You are a member of Children's Primary Care Medical Group (CPCMG), please contact your Portfolio Manager to submit your project for MOC credit.
You presented this work at the InterProfessional Symposium (IPS) conference, and you received MOC credit.

Reviewing this checklist will help you gather all the necessary information you will need to easily complete this application.

Download the physician attestation form here. You will need to upload this completed form for each physician requesting credit as a combined PDF as part of your submission.

Note: Submission of this application alone does NOT guarantee MOC Part 4 credit. Projects will be reviewed for compliance with the ABP's and RCHSD standards.

Allow up to 10 business days for the initial review of your project's compliance with the ABP's and RCHSD's quality improvement standards for MOC credit approval. You may receive an email request for clarifications or additional project information from the reviewing team. Approved small group QI projects are awarded 25 MOC Part 4 points.

1. Status of the Quality Improvement Project? *This question is required.

Stop application here; ABP MOC credits are only awarded for completed QI projects.
We welcome you to submit when your project is completed.

Stop application here; ABP MOC credits are only awarded for completed QI projects.
While your overriding smart aim can be the same across projects, each project with its own run chart must have been completed for submission.

2. Physician Submitter First Name: *This question is required. (This is the person requesting credit.)

2. Physician Submitter Last Name: *This question is required. (This is the person requesting credit.)

2. Physician Submitter date of birth: *This question is required. (This is the person requesting credit.) This question requires a valid date format of MM/DD/YYYY.

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2. Physician Submitter ABP ID: *This question is required. (This is the person requesting credit.)

2. Physician Submitter Email: *This question is required. Please enter an email here that you actually check DAILY. If we cannot reach you regarding your submission in a timely fashion, your application review may be delayed, and you may not receive credit in the calendar year you desire. This question requires a valid email address.

2. Physician Submitter Phone number: *This question is required. (Phone numbers should be provided in 111-111-1111 format.)

2. Are you a medical student, resident or fellow? *This question is required.

2. List the program and program director for your training: *This question is required.

Training Program:
Program Director:

Small Group QI Project (1-10) Physicians - Completed Project