Please complete this form and upload your supporting documentation of CME activity completion. Once your information has been verified, your MOC credit will be reported with the next appropriate quarterly reporting to the ABAI. 

 
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Enter the date you are completing the form
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Please select only three topics.
Topic
Enter a topic and an activity you completed to finish the self-assessment cycle. The activity completion date must be AFTER the completion date of the Self-Assessment quizzes to be valid.
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Select a topic from the drop-down list.
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List the activity you completed. For journal articles, include full reference information. For meetings or workshops, include date and title of meeting, relevant session attended, etc.
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Select the type of activity you completed
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Enter the date you completed this activity.
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Upload your proof of completion. Please note the allowed file types listed below.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.
Topic
Enter a second topic and an activity you completed to finish the self-assessment cycle. The activity completion date must be AFTER the completion date of the Self-Assessment quizzes to be valid.
*
Select a topic from the drop-down list.
*
List the activity you completed. For journal articles, include full reference information. For meetings or workshops, include date and title of meeting, relevant session attended, etc.
*
Select the type of activity you completed.
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Enter the date you completed this activity
*
Upload your proof of completion. Please note the allowed file types listed below.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.
Topic
Enter a third topic and an activity you completed to finish the self-assessment cycle. The activity completion date must be AFTER the completion date of the Self-Assessment quizzes to be valid.
*
Select a topic from the drop-down list.
*
List the activity you completed. For journal articles, include full reference information. For meetings or workshops, include date and title of meeting, relevant session attended, etc.
*
Select the type of activity you completed.
*
Enter the date you completed this activity.
*
Upload your proof of completion. Please note the allowed file types listed below.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.