Northwest Region Prehospital Care Program

CME Pre-Approval Form

Ensure to enter your ESH# at the bottom of the form.
You may attach a file below to help support your request.

Title of CME Event(*)

Please enter paramedic's name.

CME Hours Requested

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Date of CME Event(*)

Please enter a valid date.

Education Methods

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What is the clinical value of this elective CME?(*)

Please provide the detail of your request.

What new knowledge will you gain?(*)

Please provide the detail of your request.

Is the CME focused on low frequency, high acuity skills as a paramedic?

YES
NO Invalid Input

Please provide details

0/400

Please provide the details of your request.

Attach file

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Have you participated in the same activity for CME in the past?(*)

YES
NO

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How many years ago?

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EHSN

EHSN is a five digits number.

Name of person submitting(*)

Please enter your full name.

Email(*)

Please enter a valid email address.

Date Approved (D/M/Y - 01/01/2020)

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Approved by

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Clinical Hours Approved

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Ontario EMS and Base Hospitals work in collaboration to ensure safe quality pre-hospital patient care is provided to every patient.