№ files_lp_3_process_9_62468
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Administrative attestation form outlining participation criteria, reporting obligations, quality improvement activities, and reflection requirements for physicians seeking MOC Part IV credit within the PCIC program at UNC Health Care System.
Program:
PCIC (Practice-Based Care Improvement Collaborative)
Credit Type:
MOC Part IV Credit
Institution:
UNC Health Care System (UNC HCS)
Program Manager:
Crystal Hoffman
Document Type:
Participation Requirements and Attestation Form
Required Participation Period:
Minimum six (6) months
Reporting Requirements:
Four monthly progress reports on at least one PCIC measure
Meeting Requirements:
Two practice team meetings and two milestone meetings
Quality Improvement Methodology:
Plan, Do, Check, Act (PDCA)
Verification Method:
Electronic Attestation and Program Manager Confirmation
Target Audience:
PCIC Participants Seeking MOC Part IV Credit
Contact Email:
[email protected]
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2022
Region / City:
European Union
Theme:
Compliance Declaration
Document Type:
Technical Declaration
Organization / Institution:
EASA (European Union Aviation Safety Agency)
Author:
Accountable Manager of the Company
Target Audience:
UAS Manufacturers, Operators
Period of Validity:
N/A
Approval Date:
05.05.2022
Date of Changes:
N/A
Program:
Process Safety Management
Document type:
Form
Subject:
Management of Change (MOC)
Change scope:
Chemical, Equipment, Process Technology, Procedural, Facility, Organizational
Change status options:
Temporary, Permanent
Review tiers:
Tier 1, Tier 2
Approving roles:
Operations/Facility Manager; Building Facility/Safety; Operator (Covered Process); EHS Department; Area Supervisor; Safety Officer; Building or Utility Operations Engineer
Affected documentation:
Operating procedures; Maintenance procedures; P&ID and drawings; Process Hazard Analysis; Offsite Consequence Analysis; Emergency Response Procedures; Process Safety Information
Training and notification:
Required or not required
Pre-startup safety review:
Required or not required
Closure requirements:
Follow-up actions and formal closure comments
Responsible department:
EHS Department
Date:
03/2016
Reference code:
PSM-SOP-UN-003ata
Year:
2014
Region / City:
N/A
Subject:
Process Safety Management
Document Type:
Instructional Document
Organization / Institution:
EHS Department
Author:
N/A
Target Audience:
MOC Originators, Process Safety Program Manager
Period of Validity:
N/A
Approval Date:
08/20/2014
Date of Amendments:
N/A
Context:
Instructional document for the completion of a Management of Change (MOC) form as part of a Process Safety Management program.
Note:
Year
Topic:
Process safety management
Document Type:
Procedure
Document Type:
Implementation checklist
Purpose:
Quality improvement and Maintenance of Certification (MOC) Part 4 activity
Subject:
Annual synchronized prescription renewals
Clinical Focus:
Chronic condition medication management
Intended Setting:
Medical practice
Key Components:
Assess, Improve, Reassess and reinvigorate
Primary Actions:
Baseline measurement, prescription synchronization, maximum-duration renewals, pharmacy coordination, performance measurement
Target Audience:
Physicians and care teams
Related Resource:
Annual Prescription Renewal toolkit
Source Platform:
stepsforward.org
Year:
Current year (submission deadline November 1)
Region:
North Carolina
Country:
United States
Program:
North Carolina Maintenance of Certification (MOC) Program
Administering Organization:
Institute for Healthcare Quality Improvement (IHQI)
Affiliated Organization:
American Board of Medical Specialties Portfolio Program
Document Type:
Project application form
Subject:
Quality Improvement Project approval for MOC Part IV and PI-CME credit
Eligible Participants:
Physicians and Physician Assistants
Medical Specialties:
18 ABMS specialties (including Anesthesiology, Dermatology, Emergency Medicine, Family Medicine, Internal Medicine, Medical Genetics and Genomics, Obstetrics and Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Pathology, Pediatrics, Physical Medicine and Rehabilitation, Plastic Surgery, Preventive Medicine, Psychiatry and Neurology, Radiology, Surgery, Thoracic Surgery, Urology)
Methodologies:
A3; LEAN Model for Improvement (PDSA/PDCA); Six Sigma (DMAIC); Other
Quality Framework:
Institute of Medicine dimensions of quality (Safe, Effective, Patient-centered, Timely, Efficient, Equitable)
Review Process:
Internal NC MOC Review Committee; submission to ABMS upon approval
Submission Deadline:
November 1 of the current year
Contact Email:
[email protected]
Funding Sources:
Grant; Internal or In-Kind Funding; Industry (Pharma or Medical Device manufacturer); Other
Year:
2026
Region:
United States
Document Type:
Fee Schedule
Organization:
PALTmed
Target Audience:
CME applicants, program organizers
Base Fee:
$750 (State Chapter), $1,500–$2,000 (Non-Chapter)
Per Credit Fee:
$40–$200 per CME credit hour
Additional Fees:
Incomplete Application Fee $300, Application Late Fee $300, Post-Conference Late Fee $300, Re-Review Fee $300
Applicable Credits:
CME, CMD, ABIM MOC
Conditions:
Fees vary by membership status, application completeness, and submission timing
Year:
2026
Region / City:
-
Topic:
Trauma Care, EMS, Hospital Resources
Document Type:
Checklist
Organization / Institution:
-
Author:
-
Target Audience:
Healthcare professionals involved in trauma care
Period of Validity:
-
Approval Date:
-
Date of Changes:
-
Publication Date:
October 2024
PCI DSS Version:
4.0.1
Type:
Self-Assessment Questionnaire (SAQ)
Applicability:
E-commerce merchants using third-party payment processors, not storing cardholder data electronically
Target Audience:
E-commerce merchants
Document Changes:
Detailed revision history from 2014 to October 2024, including updates to align with PCI DSS versions 3.0–4.0.1
Appendices:
A, A1, A2, A3, B, C, D
Publication Date:
January 2025
PCI DSS Version:
4.0.1
SAQ Revision:
1
Document Type:
Self-Assessment Questionnaire and Attestation of Compliance
Standard:
Payment Card Industry Data Security Standard
Issuing Organization:
PCI Security Standards Council
SAQ Type:
SAQ A
Applicable Entities:
Merchants
Payment Channels:
E-commerce; Mail/Telephone-Order
Data Handling Scope:
Fully outsourced account data processing
Applicability Exclusions:
Face-to-face channels; Service providers
Primary Audience:
Card-not-present merchants using PCI DSS compliant third-party service providers
Document Sections:
Assessment Information; Self-Assessment Questionnaire A; Validation and Attestation Details; Appendices
Compliance Confirmation:
Third-party service providers PCI DSS compliance confirmed by merchant
Year:
2023
Region/City:
Wisconsin, USA
Topic:
Provider Certification and Compliance
Document Type:
Form
Organization/Institution:
Community Care, Inc.
Author:
Unknown
Target Audience:
Health service providers, including staff members and operators
Effective Period:
Ongoing
Approval Date:
N/A
Date of Changes:
N/A
Note:
Provider Name
Staff Job Description:
Yes/No
Training Plans:
Yes/No
Staff Competency Validation:
Yes/No
Staff Qualifications Documentation:
Yes/No
Training for Working with Frail Elders/Disabled:
Yes/No
Annual Compliance Training:
Yes/No
Staff Disease Screening:
Yes/No
Criminal and Caregiver Background Checks:
Yes/No
Excluded Individuals and Entities:
Yes/No
Transportation Providers:
Yes/No
Civil Rights/Affirmative Action Compliance:
Yes/No
Year:
2021
Region / City:
Canada
Subject:
Identification Verification, Anti-Money Laundering, Loan Documentation
Document Type:
Form
Organization / Institution:
THINK Financial
Author:
THINK Financial
Target Audience:
Borrowers, Guarantors, Solicitors, Notaries, Signing Agents
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Modifications:
Not specified
Country:
Pakistan
Issuing authority:
Ministry of National Health Services, Regulations & Coordination
City:
Islamabad
Document type:
Application form with specimen affidavit
Subject area:
Attestation of professional documents
Target professions:
Doctors, paramedics, pharmacists, homeopathics, tabibs, physiotherapists
Purpose:
Attestation of documents for overseas employment
Applicant information required:
Personal, educational, professional, and overseas employment details
Required attachments:
Attested copies of degrees, certificates, CNIC, passport, affidavit
Affidavit requirement:
Stamp paper Rs. 20/-
Applicable employment context:
Overseas job placement
Administrative location:
Pak Secretariat, Kohsar Block
Note:
Year
Topic:
Minimum Staffing Requirements for Specialty Out-Of-Home Treatment Services for Youth
Document Type:
Attestation
Organ/Institution:
New Jersey Department of Children and Families
Target Audience:
Providers of Specialty Out-Of-Home Treatment Services for youth
Year:
2014
Region / City:
Global
Topic:
Payment Application Data Security
Document Type:
Attestation
Organization / Institution:
PCI SSC
Author:
Payment Application Qualified Security Assessor (PA-QSA)
Target Audience:
Payment Application Vendors, PA-QSA
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Topic:
Animal Health, Veterinary Services
Document Type:
Health Attestation
Organization / Institution:
APHA/Defra
Author:
Registered Veterinarian
Target Audience:
Veterinarians, Certifying Officers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2025
Region / City:
Oregon
Subject:
Medicaid Grievance and Appeal System
Document Type:
Attestation
Organization:
Oregon Health Authority (OHA)
Author:
Medicaid Division, CCO Operations Unit
Target Audience:
Coordinated Care Organizations (CCOs)
Period of Action:
Contract Year 2025
Approval Date:
January 1, 2025
Amendment Date:
N/A
Year:
2025
Coordinated Care Organization:
[Not specified]
Medicaid Contract Number:
[Not specified]
Type of Document:
Attestation
Governing Body:
Oregon Health Authority
Scope:
Wraparound Policies and Procedures
Signatory Authority:
Chief Executive Officer, Chief Financial Officer, or delegated employee
Contract Reference:
Medicaid Contract, Non-Medicaid Contract, OHP Bridge-Basic Health Program Contract