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Maine Chiropractic Association Continuing Education Report Form
Reporting Period: January 1, ___________ to December 31, ____________
Please print in black ink or type and attach copies of Certificate of Attendance and or Proof of Attendance** if available.
(** Proof of attendance is needed for all
seminars - a certificate of attendance
may not be sufficient and meet the requirements. Certificates must have course name, subject of content, hours you
attended and were present, instructor, dates of course and if available an
approval code or number.)
The information contained in this report is true and
correct to the best of my knowledge.
Signature_________________________________________ Date______________________
Print Name:_______________________________________ License # _________________
Maine Chiropractic Association Continuing Education Report Form
Instructions
A Maine licensed chiropractor must beginning January1, 2004 complete a minimum of forty-eight (48) hours of continuing education per biennium (every two years) cycle. The requirements for these 48 hours must be in the form of a minimum of thirty-six (36) hours in category 1 hours. Twelve (12) hours may be obtained Category 2 credits but not to exceed 12 hours.
** Please note that MCA sponsored seminars do meet category
1 requirements. The MCA sponsors two 12
hour seminars per year, which will help you meet the 48 hour requirements.
Audits of continuing education credits will be conducted on a random basis. Evidence of completion of seminars will be the responsibility of the licensee.
REPORT FORM OVERVIEW:
Column A- Seminar Date(s)
Enter the date or dates that the seminar was attended.
Line A - is used for the name of the seminar, or the source such as a book, journal or website. Please note if the seminar is a multi-track seminar with various workshops then you will need to list each workshop, the hours of that individual workshop and proof of attendance
Line B - is used to enter the CE approval number, number of pages of the book or journal article.
The CE approval number is issued by the State Board for the formal CE program and should be listed on the certificate of attendance or roster of seminar attendance. If you are unable to locate this number please leave this blank.
** Please note that the MCA does not issue certificates of attendance. It does hold all rosters and will verify attendance if you are audited. Please list the seminar name and note MCA sponsored, and dates of seminar.
Enter the total number of CEU’s offered for the Seminar and note if Category 1 or 2.
Please attach a copy of the documentation verifying your attendance at an approved seminar.
Retain the original documents for your file. Please list the hours that you attended for the seminar Ex. 12 hours/of 12 hours or if you attend part of the seminar 6 hours /of 12 hours
Please do not write in this section of the form.
Continuing Education
Information
Please note that this material and tracking sheets are provided as a courtesy by the Maine Chiropractic Association for it members to help facilitate tracking and maintaining hours. Use of these tracking sheets and certificates of attendance does not ensure that the requirements for CEU’s have been met by the doctor. The final approval for whether a course/seminar meets the requirements for CEU’s and license renewal will be at the discretion of the Maine Board of Chiropractic Examiners.
Continuing Education Credits: Each
chiropractic doctor licensed by the Board, shall complete a minimum of twenty
four (24) units of Category 1 continuing education during the current biennium.
Beginning with the January 1, 2002 license biennium, each chiropractic doctor
shall complete thirty six (36) units of continuing education, a minimum of
twenty four (24) units in Category 1 and up to twelve (12) units in Category 2.
Beginning with the January 1, 2004 license biennium, each chiropractic
doctor shall complete forty eight (48) units of continuing education, a minimum
of thirty six (36) units in Category 1 and up to twelve (12) units in Category
2.
Please note CEUs/hours earned in the current
biennium, that are in excess of the requirements for license renewal, may not
be applied retroactively nor carried forward to a subsequent license renewal
period.
Category 1 Credits and Category 2 Credits: There shall be two (2) types of continuing professional
education approved by the Board, Category 1 and Category 2. (In each category,
the unit or hour represents one clock hour).
Category 1 activities include (documented physical
attendance required);
a.)
Courses sponsored or co-sponsored by agencies,
organizations, or institutions accredited by the United States Office of
Education, are within the health professions, and have been approved by the
Board; ** Maine Chiropractic Assoc.
Seminars are approved in the category
b.)
Courses offered by individuals sponsored by national or state professional associations,
are within the health
professions, and have been approved by the Board.
c.)
Each Category 1 course must include subject material related to
the concepts of chiropractic principles and
practice including,
but not limited to, diagnostic procedures, patient care and management.
Category 2 activities include: ( Please be conservative to
make sure you have enough hours to meet this catergory requirement.)
a.) Instruction/teaching, including teaching chiropractic students, chiropractic doctors, other health professionals
and corporations, businesses and groups interested in the subject of chiropractic health; Example: 1 hour for
each hour teaching.
b.) Preparing and publishing research papers or case studies, writing on health subjects or making presentations
to a professional audience; Example: 1 hour for each hour , must submit name and content of paper
c.) Participating in inspection programs for accreditation and/or approval of colleges or clinics, administering
and participating in programs or examinations leading to chiropractic licensure or post-graduation
certification;
d.) Self-instruction such as reading health related professional publications, and/or distance learning as it relates,
the use of health-related audio tapes, videotapes, slides, programmed instructions or computer-assisted
programs; Example: 1 hour for reading journal/periodical and up to 4 hours for a book.
e.)
Professional self-assessment programs; includes computer courses
or self testing courses
f.)
CPR certification, CPR recertification, basic/advanced first aid
training;
Chiropractic Acupuncture ***: To maintain
certification in chiropractic acupuncture methods, a licensee who holds current
certification at the time of license renewal must certify to the Board during
each biennium, that s/he has completed a minimum of twelve (12) hours of
postgraduate chiropractic acupuncture training approved by the Board. Said
hours may be applied toward satisfying the required continuing education
requirements in Chapter 6(1)(A). This means that these 12 hours also count
towards category 1 hours for the biennium period
Retention of Records: Per the office of Licensing and Regulation, the Licensee shall retain all documentation of continuing education activities for the two most recent continuing education certification periods.