Interprofessional Continuing Education Activity Request Form

The IPCE Activity Request Form (ARF) completion is the first step to request educational consultation and credit for the following disciplines: Physicians, APRNs, Nurses, and Pharmacists. Please note in order for this form to be reviewed, the activity date must be more than 90 days out from the time of submission. This form starts the information gathering process. A representative will reach out to you to have further conversation within 5 business days.


























Please select all that apply









For example: Physicians-20, Pharmacists-10, RNs-10






List names of anyone giving input on agenda topics and/or speakers.








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