University of FloridaContinuing MedicalEducationUniversity of Florida,Departmentof PsychiatryGrandRounds

EVALUATIONFORMSection #6111WEB ONLY

Program:"Severe mood and behavioral disturbance in autism: Insisting on sameness in a world that changes"
Date: September 23, 2016

Speaker: James W. Bodfish, PhD

Yourcommentsareveryimportanttous!

Pleasecompletethisevaluationso thatwemayprovidemorequalityprogramsinthefuture.

Thank you for your feedback! Updated 4/12/16

University of FloridaContinuing MedicalEducationUniversity of Florida,Departmentof PsychiatryGrandRounds

EVALUATIONFORMSection #6111WEB ONLY

Program:"Severe mood and behavioral disturbance in autism: Insisting on sameness in a world that changes"
Date: September 23, 2016

Speaker: James W. Bodfish, PhD

Thetherapeutic recommendations presentedinthis activitydidnotencourageinappropriateorexcessiveuseofproducts/devices. Agree Disagree

Theinformation presentedin thisactivitydid notserveto advancea proprietaryinterestofany commercialentity.
AgreeDisagree

ExpectedClinicalOutcomes

1.Willinformationgainedfromthisprogramresultinenhancingoptimalpatientcare? Yes No

2.Ifyes,pleaselistchange(s)youintendtomakeinyourpracticeasaresultofthisprogram.

3. / Pleaserateyourconfidenceinimplementingthesechanges.
HighconfidenceModerateconfidenceLow/Noconfidence / N/A

4. Pleaseidentifyanybarriersyouperceiveinimplementingthesechanges(selectallthatapply) CostInsurance/reimbursementissues Lackoftimetoassess/counselpatients Patientcomplianceissues

Lackofadministrativesupport/resourcesLackofconsensusofprofessionalguidelines

5. Howwillyouaddressthesebarrierstoimplementchangesinknowledgeandbehavior?

Thank you for your feedback! Updated 4/12/16

University of FloridaContinuing MedicalEducationUniversity of Florida,Departmentof PsychiatryGrandRounds

EVALUATIONFORMSection #6111WEB ONLY

Program:"Severe mood and behavioral disturbance in autism: Insisting on sameness in a world that changes"
Date: September 23, 2016

Speaker: James W. Bodfish, PhD

BasicProgramEvaluation

5= Excellent/ 4= Good/ 3= Average/2= Fair/ 1= Poor

Thank you for your feedback! Updated 4/12/16

University of FloridaContinuing MedicalEducationUniversity of Florida,Departmentof PsychiatryGrandRounds

EVALUATIONFORMSection #6111WEB ONLY

Program:"Severe mood and behavioral disturbance in autism: Insisting on sameness in a world that changes"
Date: September 23, 2016

Speaker: James W. Bodfish, PhD

6. / Thematerialwaspresentedat anappropriatelevel. / 5 / 4 / 3 / 2 / 1
7. / I havegainedknowledgethatwillimprovepatientcare. / 5 / 4 / 3 / 2 / 1
8. / Theprogrammetmyexpectationsinaccomplishingthestatededucationalobjectives. / 5 / 4 / 3 / 2 / 1
9. / Youroverallratingofthequalityoftheeducationofferedat thisprogram. / 5 / 4 / 3 / 2 / 1

10.AdditionalComments/Explanations:

11.Howcanthisprogrambeimproved? (Pleaselistbothstrengthsandweaknesses.)

12.Basedonyoureducationalneeds,pleaseprovideuswithsuggestionsforfutureprogramtopicsandformats:

Thank you for your feedback! Updated 4/12/16

University of FloridaContinuing MedicalEducationUniversity of Florida,Departmentof PsychiatryGrandRounds

EVALUATIONFORMSection #6111WEB ONLY

Program:"Severe mood and behavioral disturbance in autism: Insisting on sameness in a world that changes"
Date: September 23, 2016

Speaker: James W. Bodfish, PhD

Please print legibly

Fill this form out completely for a RECORD of your attendance to this lecture

Full name (print clearly)

State medical license number OR UFID

You MUST include your medical license number or UFID to receive credit.

Pleasecircle your title

MD DOPhDLCSWLMHCLMFTARNPRNLPN

MedicalStudentResident

FellowPsyDFacultyOther:

Please circle what type of credit is needed:CME CECEU

ThisformMUSTbecompletedandreturn by5pmthedayofthe presentationto:
Attn:Debra Krawczykiewicz or352-265-7983 (fax)

Thank you for your feedback! Updated 4/12/16