CPE Activity Form - Louisiana Pharmacists Association

CPE Activity Form

Share |

Please complete the following for your planned Continuing Pharmacy Education activity.

Please note underlined field labels have additional information. Mouse over the label to view.

ACTIVITY PLANNING
Full Name		Email Address
Place of Employment
Date of Activity		Anticipated Contact Hours
Program TitleAs it will be submitted to ACPE
Please indicate the following in planning this activity.
Appropriate Audience Size
Activity TopicPlease indicate the core pharmacy areas you expect this activity to address.
Target AudiencePlease indicate the proper activity type. Learning objectives, activity format, active learning methods, and learning assessment tools should all support this activity type.
Topic DesignatorPlease select the most appropriate category for this activity.
Click here if the activity includes discussion of off-label use.	Off-Label Use
ACTIVITY TYPE
Please select ONE of the following activity types.
Knowledge-Based (recall of facts / transmit knowledge)Requires a single thought step to answer correctly; The answer is often directly in program materials; good test takers often can answer without knowing content area.	Knowledge-Based	Application-Based (apply information learned)Requires multiple thought steps to answer correctly, each of which must be correct to get to final correct answer; More difficult for good test takers to get correct answer without knowing content area.	Application-Based
ACTIVITY DESIGN
Please provide a 2-3 sentence session description. Please develop 3-5 appropriate learning objectives for the indicated audience. Objectives should be S.M.A.R.T (Specific, Measurable, Attainable, Results-Focused, Time-Focused) and appropriate for the Activity Type. If the target audience includes Pharmacists and Pharmacy Technicians, each must have SEPARATE AND DISTINCT objectives, specific to their respective roles in Pharmacy. Active Learning Techniques and Learning Assessment Tools are required and should be appropriate for the learning objectives. Please see the Faculty Guidelines for guidance on completing this section.
Session Description
Identified GapIs this activity designed to fill a gap in knowledge or a gap in skills?
MethodsIn planning this activity, please what applicable methods were used in assessing the educational needs of your target audience?
Desired Changes in BehaviorHow will this activity create changes in behavior that will better patient care for your target audience?
Pharmacists Learning Objectives
Pharmacy Technicians Learning Objectives
Acive Learning TechniquesLPA requires the use of active learning techniques in all live and home-study activities. All active learning material should be provided to LPA prior to the release date of the activity.
Learning Assessment TechniquesLPA requires the use of appropriate learning assessment techniques. All techniques should be shared with LPA prior to the release date of the activity.
POST ACTIVITY
Please complete the following relative to after the completion of the activity.
Educational MaterialsLPA encourages copies of educational material, including take-home handouts/resources, to be provided to participants. All material should be provided to LPA prior to the release date of the activity.
Educational Materials for Print
In an effort to keep meeting costs lower, LPA provides electronic versions of all educational material pre- and post-convention (unless otherwise specifically requested). Please list any of the material that you request be printed and available to all attendees at the convention.
Materials to Print
PRESENTATION NEEDS
LPA provides a podium with wired microphone, laptop, projector and screen. Please list any other requests for your activity.
Requests	Access to Internet Audio/Sound for Full Audience CD Player Cordless Microphone Lavalier Microphone
Additional Needs

	Edit This Favorite
Name:
Category:
Share:	Yes No, Keep Private

Edit This Favorite