Ohio Chapter,AmericanAcademyof PediatricsMOBI 2014Presentation Forms

Instructions for Online Forms

March 2014

ohioaap.org/projects/maximizing-office-based-immunization-mobi

The following forms are now available online to cut down on paper waste and streamline the process of scheduling, conducting, gaining feedback and evaluating MOBI trainings:

  • Program Planner
  • Attendance List
  • Trainer Feedback
  • One Month Follow-Up
  • Six Month Follow-Up

Program Planner –Trainers fill this form out after scheduling a training with a practice in order for the MOBI materials to be sent. This will allow the MOBI Office to more efficiently process and send out materials.

  • Fill in the requested information and be sure to specify MOBI or TIES training.
  • The materials (Office Resource Pack, Attendee Resource Pack(s), Planning Packet, Return Envelope, Pink Book) will be mailed directly to the trainer.
  • You MUST fill this out at least 2 weeks prior to the training date to allow time for the materials to arrive.
  • Do not provide this link to a practice to complete, it must be filled out by a trainer.
  • If you do not receive an email confirmation, contact the MOBI Office.

Attendance List – Trainers fill this form out after a training with the information attendees provide on the paper attendance form. This will allow the MOBI Office to more efficiently report information for continuing education.

  • Be sure to specify MOBI or TIES training.
  • Fill out the requested information. Address, city, state and ZIP may be left blank if the attendee did not fill out this section.
  • You MUST include the paper attendance form in the packet you mail back to the MOBI office in order for attendees to get continuing education credit.
  • If you do not receive an email confirmation, contact the MOBI Office.

Trainer Feedback – Trainers fill this form out immediately following the training. The MOBI planning team will review this information and changes to the presentation or materials may be made based on this information.

  • Fill out the requested information
  • Be sure to specify MOBI or TIES training.
  • If you do not receive an email confirmation, contact the MOBI Office.
  • Once you click “submit,” the information is sent to the MOBI Office for review.

One Month Follow-Up – Trainers fill this form out approximately one month after the training to see if the practice has taken any action steps on the items identified during the MOBI training.

  • Contact the practice immunization expert to answer the questions on the form.
  • Be sure to specify MOBI or TIES training.
  • Do not give this link to practices to fill out, it must be filled out by a MOBI trainer.
  • Once you click “submit,” the information is sent to the MOBI Office for review.

Six Month Follow-Up – The MOBI Office will contact the office immunization expert to answer the questions on this form.

MOBI March2014