Continuing Professional Education Prior Approval Request Form

Hours are requested for: Registered Dietitians Dietetic Technicians, Registered CPE Online Database -- www.cdrnet.org/application/CPE/index.cfm

For CDR use only

Program Number

Program Title: Program Provider: Program Date(s): Estimated # of RDs/DTRs in Attendance Program Location (City & State) Target Audience __ RDs __ DTRs __ Other Estimated # of RDs/DTRs in Attedance Check here program is is closed/by invitation __ Checkhere ifif program closed/by invitation onlyonly __ Program Chair Contact Person- This person recieve Certi cates Attendance & additional materials Contact Person- Thisperson willwill recieve Certiofcates of Attendance & additional materials Address

Required Documentation: The following must be provided with this form: 1. Educational objectives, describing anticipated outcomes for each session. 2. A timing outline, detailing all time spent in sessions, meals, breaks and such. This is to ensure all hours are awarded for learning time only. 3. Information regarding the target audience. 4. Quali cations of speakers/presenters. These should be resumes or CVs.
Some A liate Dietetic Associations share the CPE approval responsibility with CDR. Please review the Prior Approval Review Contact List at www.cdrnet.org/pdrcenter/a liate.htm to determine where to submit your request form for review.

Please Indicate Activity Type:

Journal Club Workshop Certi cate Program

Seminar/Lecture/Webinar Experiential Skills Development Residency and Fellowship Programs

Study Group Poster Sessions Exhibits

Information on CPEUs Requested:

Email__ Phone Daytime Fax Daytime Phone Email Fax

As a Program Provider, I verify that the content of this continuing education program is education beyond the basic preparation required for initial entry into the profession for the Registered Dietitan and/or the Dietetic Technician, Registered.

Number of contact hours: Applicable Learning Need Code(s):

(See Page 2 for LNC List)

Exhibits: CPEU Level:

Level 1: Level 2: Level 3:

Posters:

Little or no prior knowledge of subject General knowledge of literature and professional practice in areas covered Thorough knowledge of literature and professional practice in areas covered

For Continuing Professional Education Committee Use Only Date Approved by Maximum Hours Exhibit Hours Poster Sessions

Signature of Program Provider

Date

Disapproved by

Note: Approval of CPEU hours acknowledges the need for an objective look at the information being presented. Endorsement of presentations is not the function of CDR.

Send this form to CDR! 120 South Riverside Plaza, Suite 2000, Chicago, Illinois 60606-6995 You may also fax it to 312-899-4772 Questions? Call 1-800-877-1600 xt. 5500 and ask for the Prior Approval contact.

RC-3 05/09

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LEARNING NEED CODES QUICK REFERENCE

1000
1010 1020 1030 1040 1050 1060 1070 1080 1090 1100 1110 1120 1130 1140

PROFESSIONAL SKILLS

Career planning, job search, goal setting Computer, electronic technology CPR Cultural sensitivity Ethics Foreign language Leadership, critical and strategic thinking Legislation, public policy Media skills Photography, video and graphic production Risk taking Time and stress management, life balance Verbal comm. skills, presentations Written comm. skills, publishing

4130 4140 4150 4160 4170 4180 4190

Pregnancy Lactation Infancy & Childhood Adolescence Mens health Womens health Elderly nutrition Acute Ambulatory Home care LTC, intermediate, assisted living Rehabilitation Neonates Pediatrics Adolescents Adults Elderly Allergies, sensitivities Autoimmune disease, arthritis, lupus Bone diseases, osteoporosis Burns Cancer Cardiovascular disease Critical care, trauma Developmental disorders Diabetes mellitus Disordered eating Dysphagia GI Disorders Hematological disorders, anemia Hepatic Disorders HIV/AIDS HTN Infectious disease Nutrient deficiencies Metabolic disorders, Inborn errors Neurological: stroke, Alzheimers, dementia, Parkinsons, spinal cord injuries Pregnancy complications Psychiatric disorders, anxiety Pulmonary diseases Renal diseases Substance abuse Transplantation Weight management, obesity Wound care Care planning, documentation, and eval. Case management Client Protocols, clinical guidelines Complementary Care, alternative therapies End of life care Enteral and parenteral nutrition support Feeding equip, tube placement, adaptive utensils Self-care management Behavior change theories, techniques Counseling, therapy, and facilitation skills

6030 6040 6050 6060 6070 6080 7010 7020 7030 7040 7050 7060 7070 7080 7090 7100 7110 7120 7130 7140 7150 7160 7170 7180 7190 7200 7210 8010 8015 8018 8020 8030 8040 8050 8060 8070 8080 8090 8100 8110 8120 8130 9010 9020 9030 9040 9050 9060 9070

5000
5010 5020 5030 5040 5050 5060 5070 5080 5090 5100 5110 5120 5130 5140 5150 5160 5170 5180 5190 5200 5210 5220 5230 5240 5250 5260 5270 5280 5290 5300 5310 5320 5330 5340 5350 5360 5370 5380 5390 5400 5410 5420 5430 5440 5450 5460 6010 6020

MEDICAL NUTRITION THERAPY (MNT)

Educ. theories and techniques for adults Educ. theories and techniques for children and adolescents Instructional materials development Learning needs assessment, LP development, and evaluation Interviewing and listening skills Training, coaching, and mentoring Business plan development Conflict management Contract management Consultation Customer focus Emergency and disaster management Entrepreneurship, private practice Financial management Human resources management, labor relations Institution/regulatory policies and procedures, HCFA, OBRA, JCAHO, NCQA, OSHA, USDA Legal issues, malpractice Marketing Managed care Materials management Negotiation Quality management Reimbursement, coverage Strategic planning Supervision, crisis management Team building Sales, merchandising

7000 BUSINESS AND MANAGEMENT

2000
2010 2020 2030 2040 2050 2060 2070 2080 2090 2100 2110

Botanicals, phytochemicals Composition of foods, nutrient analysis Food preservation, additives, irradiation Food science, genetically modified food Genetics Immunology Macronutrients: CHO, Protein, Fat, Fiber, and Water Microbiology, food toxicology Micronutrients: vits, minerals Nutritional biochemistry Physiology, exercise phys. Assessment methodology Assessment of target groups Anthropometrics, body comp Food consumption, fluid balance Feeding, swallowing, dentition Laboratory tests Pharmacological, drug/nutrient, herbal interaction Physical: BP, pulse, bowel sounds Screening parameters, methodology, and surveillance Supplemental nutrients, botanicals

SCIENCE OF FOOD AND NUTRITION

8000 FOOD SERVICE AND CULINARY ARTS

3000
3010 3020 3030 3040 3050 3060 3070 3080 3090 3100

NUTRITION ASSESSMENT

4000
4010 4020 4030 4040 4050 4060 4070 4080 4090 4100 4110 4120

WELLNESS AND PUBLIC HEALTH

Community Intervention, monitoring, and evaluation Community prgm. development Dietary guidelines, DRIs, FGP, food labeling Disease prevention Epidemiology Exercise, fitness, and sports nutr. food security and hunger Govt-funded Food & Nutrition Programs Health behaviors: smoking cessation, stress management Social marketing Vegetarianism Life Cycle

Child and Adult Care Food Program Cultural/ethnic food &culinary practice Environmental, agricultural, and technologic influences on food systems Equipment management Facilities layout, planning Food safety, HACCP, and sanitation Food distribution and service Food presentation Food production, purchasing Food styling Menu planning, nutrient analysis Recipe and food development School foodservice Sales, merchandising Sensory perception and evaluation of food and ingredients Data analysis Evaluation and application of research Outcomes research, cost-benefit analysis Proposal development, grant applications Publication, communications of research outcomes Research development and design Research instruments and techniques

9000 RESEARCH AND GRANTS

6000 EDUCATION, TRAINING, AND COUNSELING