AGD-PACE Joint Program Provider Forms & Agreements
To ensure compliance with AGD PACE requirements and uphold the integrity of the continuing education program, all joint program provider activities must be supported by appropriate documentation.
Click the links below to jump to the required forms for each role involved in the joint program provider program
Joint Program Provider (Company)
Instructors:
1: Disclosures of Financial Relationships (Sign Annually)
This form must be completed prior to delivery of the CE Activity. In order for the CE Zoom planners to identify, prevent and mitigate conflicts of interest in the creation and delivery of the educational content, disclosure of financial relationships between the Instructors and commercial entities must be made known to CE Zoom. (CERP, (V.12)) (PACE, (XII-C-(G))
2: Affidavit of Image Authenticity & HIPAA Compliance (Sign for Every CE Activity)
A signed form must be obtained from all course instructors for each CE Activity. Instructors are to attest to taking the necessary steps to ensure that images and discussion of patients in the CE Activity is done so without falsification or misrepresentation of patient outcomes and the proper patient consent has been obtained. (CERP, VII-C-(8)) (PACE, VIII-C-(E))
Joint CE Program Provider (Company):
1: Joint Program CE Provider Agreement (Sign Annually)
When two or more organizations work together to offer educational activities, the AGD Council recommends that a written plan or agreement is developed before committing to the CE activity to ensure that all parties involved are clearly aware of each other’s responsibilities to ensure a successful program. All organizations are required to sign this form prior to the delivery of the CE Activities with CE Zoom. This will serve as documentation of the organization's responsibility to adhere to and work in accord with the “Joint Program Provider Policy and Procedures” when entering into a contracting arrangement with CE Zoom. The Joint Program Provider agreement is valid for 365 days, upon signature.
2: Disclosures of Financial Relationships (Sign Annually)
This form must be completed prior to delivery of the CE Activity. In order for the CE Zoom planners to identify, prevent and mitigate conflicts of interest in the creation and delivery of the educational content, disclosure of financial relationships between the Instructors and commercial entities must be made known to CE Zoom. (CERP, (V.12)) (PACE, (XII-C-(G))
Documents:
1. CE Zoom's & AGD-PACE Joint Program Provider Policies & Procedures (Read Only)
All organizations working with CE Zoom Partners, LLC must understand and follow AGD-PACE Standards when delivering a CE Activity. This document outlines those standards along with CE Zoom’s policies—please read and reference it when submitting course materials.
2. AGD-PACE Program Guidelines (Read Only)
All organizations partnering with CE Zoom must understand and follow the 13 AGD-PACE Program Standards. CE Zoom requires full compliance with these guidelines for all CE Activities.