North Carolina Physician 6-Month CME Program

Application Process

#### Application Submission
Submission Method: Online form at neuroimmune.org/nc/apply-for-six-month-cme-program/

Status: Application form active as of latest update (April 2025)

#### Required Information
1. Personal Information:
- First name
- Last name
- Professional email address (practice/employment email required for verification)

2. Practice Information:
- Practice name
- Practice mailing address (street address, optional address line 2, city, state, ZIP)
- Practice email

3. Professional Credentials:
- Professional type: MD/DO, NP/PA, or Medical Student (proof required)
- NPI number
- Patient population: Pediatric, Adult, or Both

4. Practice Type:
- Select from: Private practice, Clinic, Hospital

5. Insurance/Payer Information:
- Checkbox: Practice is in-network with several insurance providers
- Checkbox: Practice takes Medicaid
- Checkbox: Practice does not take insurance

6. Program Participation:
- Question: "Would you like to also join the weekly live ECHO sessions?"
- Options: Yes definitely, No, Maybe

7. Compensation Track Selection:
- Select one:
- "Free CME and stipend for CME" (note: formal contract required; limited compensated seats via lottery)
- "Just Free CME" (all North Carolina physicians qualify)

8. How did you hear about program:
- Email, Fax, Phone Call, Flyer, Mail, Social Media

#### Verification

#### Approval Process