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Lecture Request Form
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Requestor Information
Name
*
First
Last
Title
University/Organization
University of Florida/UF Health
Florida State University
University of Central Florida
Florida Atlantic University
Florida International University
Other
Department/Service
*
Email Address
*
Phone Number
Event Details
Lecture Topic
*
SIP 101 Orientation
Apology and Disclosure
Documentation
Medical Error Prevention
End of Life Issues
Witholding/Withdrawing of Life-Prolonging Treatment and Measures
Taking Time Out to Avoid Wrong Site Surgery
Leave Nothing behind: Preventing Unplanned Retained Surgical Items
Legal Perspectives on Pressure Injuries
Informed Consent
Liability and Medical Malpractice
Sexual Misconduct Allegations in Healthcare: Clinical Considerations
Medical & Legal Aspects of the Electronic Medical Record
Alternative Dispute Resolution
Patient Safety Act
Defending Your License
Deposition Prep
Identifying, Understanding, and Handling Legal Documents
I want to Speak to my Lawyer: Ex-Parte Conversations with Lawyers
Other (Describe in “Comments” below)
Type of Event
*
Examples: Department Meeting, New Resident Orientation, Quarterly Executive Meeting
Estimated Number of Attendees
*
Audience Description
*
As best as possible, please describe who will be in attendance by status (e.g., attendings, residents, students), license type, and specialty. This information will help with the presentation build.
Total Amount of Lecture Time
*
Please Select
15 minutes
30 minutes
45 minutes
60 minutes
Other
Date / Time of Event
*
Date
Time
Please try to allow for at least 30 days advance notice.
Are you applying for CME credits for this educational activity?
*
YES
NO
UF Health Providers: If you would like CME credits for the lecture, please contact the UF Continuing Medical Education program or apply at the following link: https://cme.ufl.edu/apply/. NOTE: The SIP does not apply, nor is responsible, for CME credits related to our lectures. This effort must be handled by the requesting service.
Address of Event (if attendance will be online, please indicate such in comments)
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Comments
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