1 Start 2 Complete
Section 1: Project Metadata
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6-7 digit ID required for credit reporting. This is NOT your NPI.
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MM/DD/YYYY
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First Name, Last Name, Degree
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Section 2: Clinical Impact & Scope
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Please list the exact number of Physicians who meaningfully participated in this QI project
Please list the amount of Physician Assistants who meaningfully participated in this QI project
Please list the # of Residents who meaningfully participated in this QI project
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Which of the six Institute of Medicine (IOM) dimensions were impacted by this study? (Check all that apply)
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Which of the following ACGME Core Competencies were impacted by this study? (It is assumed that all QI projects address Practice Based Learning and Systems Based Practice. Please check all others that apply)
Section 3: Participant Data
Attestation of participation in MOC4/QI Project/Poster Please Note: To ensure all participants receive appropriate MOC Part 4 credit, you will need their Board ID Number (specific to their specialty board, e.g., ABIM), Date of Birth, Email Address, NPI Number, Medical Board Number, and Board ID Number. Please ensure you have these details ready before proceeding. For projects with multiple team members, select the number of participants below to reveal additional entry fields.
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Participant Name (Last, First, Title) Must match Board records.
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Board ID Number Required for MOC credit transmission. *May be different from your subspecialty number
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Please list your Specific Medical Board
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Your full birthdate is required for learner validation
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Please include your full NPI Number
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Additional Participant Details
Please provide the credentials for the additional meaningful participant. All fields below are required for MOC credit reporting.