TUFTS UNIVERSITY SCHOOL OF MEDICINE
"Redefining Chronic Renal Insufficiency:
A Panel Discussion on the Emerging Role of Anemia"
Post-Test / Evaluation Form
In order to successfully complete this activity, you are required to read or listen to the entire web-based presentation, legibly complete this Post-Test / Evaluation Form, and achieve a minimum passing grade of at least 70% on the Post-Test. The Post-Test / Evaluation Form must be submitted by December 31, 2002.
Certificates will be mailed within 4-6 weeks after receipt to those who successfully complete the Post-Test/Evaluation form. There is no registration fee to participate in this activity.

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Degree____________     Position/Title __________________
Mailing Address for Certificate:

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Signature __________________________________     Date ____________
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Mark the answer that is correct for each PostTest question below: First click on the Post-Test Questions link and print out the questions for your reference.

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Evaluation of Objectives
Please rank how well the program objectives were met in the following topic areas.

Participants should be able to: High ----- ----- ----- Low
Discuss prevalence, severity, and management of anemia in CRI 5 4 3 2 1
Recognize the link between management of CRI and clinical outcomes 5 4 3 2 1
Understand the clinical rationale for early referral and treatment of anemia in CRI patients 5 4 3 2 1
Recognize the Renal Anemia Management Period (RAMP), a new and novel approach to identifying and treating CRI-related anemia in patients 5 4 3 2 1
Understand the need for partnering with general practitioners and family physicians to increase patient identification and referral 5 4 3 2 1

Evaluation of Speakers and Panel High ----- ----- ----- Low
Dr. Brian Pereira .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1
Dr. Adeera Levin .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1
Dr. David Churchill .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1
Dr. Roger London .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1
Dr. Steven Fishbane .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1
Dr. Allen Nissenson .
Content relevant to my practice 5 4 3 2 1
Was able to communicate relevant knowledge of subject 5 4 3 2 1

Overall Seminar Evaluation High ----- ----- ----- Low
Potential impact on my practice 5 4 3 2 1
It will help me improve my professional effectiveness 5 4 3 2 1
Overall the seminar met my expectations 5 4 3 2 1
Avoided commercial bias or influence 5 4 3 2 1


Any additional comments about this activity?
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Any suggestions for future self study programs on this or other subjects?
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Please fax this completed Post-Test/Evaluation Form to 617-636-0472, or mail to: Tufts University School of Medicine; Office of Continuing Education; 136 Harrison Avenue; Boston, Massachusetts 02111.