Name
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Email Address
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Date you viewed the presentation:
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Today M-D-Y
Are you an Ascension employee or affiliated or credentialed with an Ascension hospital?
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Yes No
Which facility are you employed, affiliated or credentialed with?
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Which Ministry Market are you employed, affiliated or credentialed with?
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Ascension Indiana Ascension Michigan Ascension Tennessee Ascension Texas Ascension Wisconsin Ascension Alabama Ascension Florida Ascension Kansas/Oklahoma Ascension Amsterdam Ascension Baltimore/Washington Ascension Binghamton Ascension Bridgeport Ascension National Ascension AMITA Ascension DePaul Services
Which hospital are you employed, affiliated or credentialed with?
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St. Vincent Kokomo Hospital St. Vincent Indianapolis Hospital St. Vincent Neighborhood Hospital- Castleton St. Vincent Women's Hospital St. Vincent Anderson Regional Hospital St. Vincent Evansville St. Vincent Heart Center of Indiana St. Vincent Carmel Hospital St. Vincent Fishers Hospital St. Vincent Randolph Hospital St. Vincent Jennings Hospital St. Vincent Williamsport Hospital St. Vincent Mercy Hospital St. Vincent Clay Hospital St. Vincent Salem Hospital St. Vincent Warrick St. Vincent Dunn Hospital St. Vincent Neighborhood Hospital - Avon St. Vincent Hospital for Women & Children St. Vincent Rehabilitation Institute Peyton Manning Children's Hospital at St. Vincent St. Vincent Neighborhood Hospital - Indianapolis South St. Vincent Seton Specialty Hospital St. Vincent Stress Center Ascension St. Vincent Orthopaedic Hospital St. Vincent Neighborhood Hospital - Noblesville South St. Vincent Neighborhood Hospital - Plainfield Daviess Community Hospital Rehabilitation Hospital of Indiana Indiana Orthopaedic Hospital Ascension Medical Group
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Ascension Allegan Hospital Ascension Borgess Hospital Ascension Borgess Lee Hospital Ascension Borgess Pipp Hospital Ascension Brighton Center for Recovery Ascension Genesys Hospital Ascension Providence Hospital - Novi campus Ascension Providence Hospital - Southfield campus Ascension Providence Rochester Hospital Ascension River District Hospital Ascension St. John Hospital Ascension St. John Macomb-Oakland Hospital - Madison Heights campus Ascension St. John Macomb-Oakland Hospital - Warren campus Ascension St. Joseph Hospital Ascension St. Mary's Hospital Ascension Standish Hospital Ascension Medical Group
Which hospital are you employed, affiliated or credentialed with?
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Saint Thomas Rutherford Hospital Saint Thomas West Hospital Saint Thomas Midtown Hospital Saint Thomas Dekalb Hospital Saint Thomas River Park Hospital Saint Thomas Highlands Hospital Saint Thomas Stones River Hospital Saint Thomas Hospital for Specialty Surgery St. Thomas Hickman Hospital Ascension Medical Group
Which hospital are you employed, affiliated or credentialed with?
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Ascension Providence Ascension Seton Medical Center Austin Dell Seton Medical Center at The University of Texas Ascension Seton Smithville Ascension Seton Southwest Ascension Seton Northwest Ascension Seton Highland Lakes Ascension Seton Edgar B Davis Ascension Seton Williamson Ascension Seton Hays Dell Children's Medical Center Ascension Seton Shoal Creek Ascension Providence DePaul Center Central Texas Rehabilitation Hospital Cedar Park Regional Medical Center Seton Medical Center Harker Heights Warm Springs Rehabilitation Hospital of Kyle Ascension Medical Group
Which hospital are you employed, affiliated or credentialed with?
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Ascension Columbia St. Mary's - Ozaukee Ascension Columbia St. Mary's - Milwaukee Ascension St. Michael's Hospital Ascension St. Mary's Hospital Howard Young Medical Center Ascension St. Clare's Hospital Ascension Eagle River Hospital Ascension Our Lady of Victory Hospital Ascension Sacred Heart Hospital Ascension Calumet Hospital Flambeau Hospital Ascension Good Samaritan Hospital Ascension St. Francis Hospital Ascension All Saints Hospital- Wisconsin Avenue Campus Ascension All Saints Hospital - Spring Street Campus Ascension SE Wisconsin Hospital - Elmbrook Campus Ascension SE Wisconsin Hospital - Franklin Campus Ascension SE Wisconsin Hospital - St. Joseph Campus Midwest Orthopedic Specialty Hospital Saint Elizabeth's Medical Center Ascension NE Wisconsin - St. Elizabeth Campus Ascension Sacred Heart Rehabilitation Hospital Ascension NE Wisconsin - Mercy Campus Orthopaedic Hospital of Wisconsin (OHOW) Ascension Medical Group
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Providence Hospital St. Vincents East St. Vincents Birmingham St. Vincents St. Clair St. Vincent's Chilton St. Vincents Blount St. Vincent's Health System Ascension Medical Group
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Sacred Heart Hospital in Pensacola Bay Medical Sacred Heart Sacred Heart Hospital Emerald Coast Sacred Heart Hospital Gulf Coast Ascension St. Vincent's Riverside Ascension St. Vincent's Southside Ascension St. Vincent's Clay County The Studer Family Children's Hospital at Sacred Heart Ascension Medical Group
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Ascension Via Christi Hospital in Pittsburg Ascension Via Christi St. Francis Ascension Via Christi St. Joseph Ascension Via Christi Hospital in Manhattan Ascension Via Christi St. Teresa Wamego Health Center Ascension Via Christi Rehabilitation Hospital Ascension Via Christi Behavioral Health Salina Regional Health Center Kansas Surgery and Recovery Center Kansas Heart Hospital McPherson Hospital Jane Phillips Medical Center St. John Medical Center St. John Owasso St. John Broken Arrow Jane Phillips Nowata Health Center St. John Sapulpa St. John Rehabilitation Hospital St. John Rehabilitation Hospital Ascension Medical Group
Which hospital are you employed, affiliated or credentialed with?
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St. Mary's Healthcare Ascension Medical Group
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St. Agnes Hospital Seton House Ascension Medical Group Providence Health System
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Our Lady of Lourdes Memorial Hospital Ascension Medical Group
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St. Vincent's Medical Center St. Vincent's Behavioral Health Services Ascension Medical Group
Which hospital are you employed, affiliated or credentialed with?
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AMITA Health Mercy Medical Center AMITA Health Resurrection Medical Center AMITA Health Saint Joseph Hospital, Chicago AMITA Health Saints Mary and Elizabeth Medical Center, Saint Elizabeth Campus AMITA Health Saints Mary and Elizabeth Medical Center, Saint Mary Campus AMITA Health Holy Family Medical Center AMITA Health Saint Joseph Hospital, Elgin AMITA Health Alexian Brothers Medical Center Elk Grove Village AMITA Health Rehabilitation Hospital Elk Grove Village AMITA Health Saint Francis Hospital AMITA Health St. Alexius Medical Center Hoffman Estates AMITA Health Women & Children's Hospital Hoffman Estates AMITA Health Alexian Brothers Behavioral Health Hospital Hoffman Estates AMITA Health Saint Joseph Medical Center AMITA Health St. Mary's Hospital
Identify which continuing education hours apply for you:
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MD DO PA NP CRNA RN PharmD RPh Pharmacy Tech Student PT OT Social Worker Chaplain Other
PHARMACY ONLY: NABP #
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PHARMACY ONLY: DOB (Month/Day)
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Did the speaker(s) meet each of the objectives?
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What change(s) will you make in your role on the healthcare team as a result of this activity?
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What new team-based patient care strategies will you employ as a result of this activity?
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How will your role in the collaborative team change as a result of this activity
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Did the information presented reinforce and/or improve your current skills?
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Do you perceive any barriers in applying these changes?
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What are the other barriers in applying these changes?
Speakers knowledge of Subject Matter
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Quality of Presentation & Handouts
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Excellent Good Average Poor
Overall activity
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Did the speaker provide an opportunity for questions and discussion?
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Did you perceive commercial bias or any commercial promotional products displayed or distributed.
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Do you plan to share information learned with other members of your practice team?
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Please summarize how you plan to share the information
I will apply the knowledge and/or skills gained during this activity in my work:
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State one thing that you will apply
What other CE/CME topic(s) would you like to attend?
From recent data, the most frequently occurring type of workplace violence is patient on associate.
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True
False
You do not need to consider non-verbal behavior when attempting to de-escalate situations.
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True
False
Workplace violence events should be reported in the Event Report System.
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True
False
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