Epic Thrive Program: Session Form

In order for a live session of the Epic Thrive Program to be approved for accreditation, please complete the following form. An * indicates the field is required. At the end of the form, click the Submit button.

The form should be submitted no later than two weeks after the live activity date.

If you have immediate questions or concerns, please email: moreinfo@optumhealtheducation.com.

Submitter’s Information

First Name *

Last Name *

E-mail *

E-mail Confirmation *

Activity Information

Title *

Presenter *

Presenter Other:

Date activity was held *

Month

Day

Year

Activity Location *

Livestreamed

In-Person

City *

State *

Attendee Breakout

Lesson Type *

Provider Lesson

Total Number of Attendees at Provider Lesson *

Total Number of Attendees at Support Staff Lesson *

Number of Physicians at Provider Lesson (ONLY MDs and DOs) *

Out of the total number of attendees, how many were MDs and DOs?

Remaining Number of Attendees at Provider Lesson (Total attendance minus MDs & DOs) *

Excluding MDs & DOs, please note the remaining amount of participants in attendance.

Number of Nurses at Support Staff Lesson (Nurses ONLY) *

Out of the total number of attendees, how many were nurses?

Remaining Number of Attendees at Support Staff Lesson (Total attendance minus nurses) *

Excluding nurses, please note the remaining amount of participants in attendance.

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Submitter’s Information

Activity Information

Attendee Breakout