Record Keeping Form

You were randomly selected for participation in the audit. While you will not have to document any Certification Maintenance Hours (CMHs) that you have earned through your participation in the CE Registry, you will need to submit a Record Keeping form (list of activities) and documentation of participation/attendance for any hours that are not documented for you by CE.

Tracking your CMHs

You have 8 CMHs (5 Courses) available but not on your Transcript.

These courses cannot count towards the audit unless you participate in the ASHA CE Registry.

ASHA CE Registry Hours

These courses are already accounted for in your CE Registry Transcript, you do not need to provide documentation for them.

Activity Oticon Core Concepts Training 2012

SIEMENS

5 CMHs

mm/dd/yy

No Documentation Required

Another Name of an Activity

Provider Name

5 CMHs

mm/dd/yy

No Documentation Required

Another Name of an Activity

Provider Name

5 CMHs

mm/dd/yy

No Documentation Required

Total CE Registry Hours: 15

Self Reported Hours

Please account for the 20 CMHs not accounted for on the CE Registry in the Record Keeping Form below.

Add Activity

Activity Oticon Core Concepts Training 2012

SIEMENS

5 CMHs

mm/dd/yy

Documentation Required

Another Name of an Activity

Provider Name

5 CMHs

mm/dd/yy

Accepted

Another Name of an Activity

Provider Name

5 CMHs

mm/dd/yy

Rejected

Total Self Reported Hours: 15

Combined Total Hours: 30

Please submit this form no later then [mm/dd/yyyy].


Active Interval: Jan 1, 2013 - Dec 31, 2015

Status: In Audit

All self reported hours must be completed within your interval dates above.


If you need to include hours that occurred outside that interval, please apply for an extension.

CMH Audit Status

CE Transcript Hours: 15

Self Reproted Hours: 15

  • Approved Hours: 10

  • Rejected Hours: 5

Combined Total Hours: 25