Pre-Approval of Specialty CME Credit
For Sponsors of CME Programs
Organization Name Click here to enter text. Sponsor ID (if known) Click here to enter text.
AOA Accredited Category 1A CME Sponsor ☐
Address Click here to enter text.
City, State, Zip Click here to enter text.
Contact Name Click here to enter text. Email Address Click here to enter text.
Event Name Click here to enter text.
Event Dates Click here to enter text. Location (City, State) Click here to enter text.
Session(s) for Which Specialty CME is Sought
Session 1 / Session 2 / Session 3Session Title / Click here to enter text. / Click here to enter text. / Click here to enter text.
Date and Time of Session / Click here to enter text. / Click here to enter text. / Click here to enter text.
Presenter / Click here to enter text. / Click here to enter text. / Click here to enter text.
Board Certification or Other Credentials / Click here to enter text. / Click here to enter text. / Click here to enter text.
Learning Objectives / Click here to enter text. / Click here to enter text. / Click here to enter text.
Use the second page of this form to indicate the specialties for which specialty CME pre-approval is requested. Visit the individual board websites for a listing of specialty tables of specification for help if needed. For additional sessions, use an additional form and include as one submission to the AOA.
Please note that all specialty credit is acceptable for Family Medicine/OMT.
Submit this form and agenda to or mail to:
American Osteopathic Association
Division of Certification
Attn: Leo Morales-Egizi
142 E. Ontario Street
Chicago, IL 60611-2864
Specialties (mark the number of specialty credits being sought per session)
Board / DESCRIPTION / 1 / 2 / 3 / Board / DESCRIPTION / 1 / 2 / 3Anesthe-siology / Anesthesiology / Pathology / Anatomic Pathology
Pain Management / Anatomic Pathology & Lab Medicine
Critical Care / Forensic Pathology
Derma-tology / Dermatology / Laboratory Medicine
MOHS Micrographic Surgery / Pediatrics / Adolescent Medicine
Pediatric Dermatology / Neonatology
Emergency Medicine / Emergency Medical Services / Pediatric Allergy & Immunology
Emergency Medicine / Pediatric Endocrinology
Medical Toxicology / Pediatric Pulmonology
Family Physicians / Adolescent & Young Adult Medicine / All
credits apply / Pediatrics
Family Medicine/OMT / Physical Medicine & Rehab / Physical Medicine & Rehabilitation
Geriatric Medicine
Internal Medicine / Cardiac Electrophysiology / Preventive Medicine / Preventive Med-Aerospace Medicine
Cardiology / Preventive Med-Occupational Med
Critical Care Medicine / Preventive Medicine-Public Health
Endocrinology / Preventive-Occupat’l-Environm’l Med
Gastroenterology / Proctology / Proctology
Geriatrics / Radiology / Angiography & Intervention Radiology
Hematology / Body Imaging
Infectious Diseases / Diagnostic Radiology
Internal Medicine / Diagnostic Roentgenology
Interventional Cardiology / Diagnostic Ultrasound
Nephrology / Neuroradiology
Oncology / Nuclear Radiology
Pulmonary Diseases / Pediatric Radiology
Rheumatology / Radiation Oncology
Neurology & Psychiatry / Child Neurology / Radiation Therapy
Child Psychiatry / Radiology
Geriatric Psychiatry / Vascular/Interventional Radiology
Neurology / Surgery / Cardiothoracic Surgery
Neurophysiology / Critical Care Surgery
Psychiatry / Facial Plastic Surgery
Neuromus-culoskeletal Medicine / Neuromusculoskeletal Med/OMM / General Vascular Surgery
Spec Prof in Osteopathic Manipulative Medicine / Neurological Surgery
Nuclear Medicine / Nuclear Medicine / Plastic & Reconstructive Surgery
Obstetrics & Gynecology / Female Pelvic Med/Reconstructive Surgery / Surgery (General)
Gynecological Oncology / Thoracic Cardiovascular Surgery
Maternal & Fetal Medicine / Thoracic Surgery
Obstetrics & Gynecologic Surgery / Urological Surgery
Obstetrics & Gynecology / Conjoint / Addiction Medicine
Reproductive Endocrinology / Allergy and Immunology
Ophthal-mology & Otolaryn-gology / Ophthalmology / Correctional Medicine
Otolaryngology & Facial Plastic Surgery / Dermatopathology
Otolaryngic Allergy / Hospice and Palliative Medicine
Otolaryngology / Pain Medicine
Otorhinolaryngology / Sleep Medicine
Orthopedic Surgery / Hand Surgery / Sports Medicine
Orthopedic Surgery / Undersea and Hyperbaric Medicine