Physician Participation and Reflection Attestation

This attestation must be completed by each certified physician seeking MOC Part IV credit from one of more of the participating ABMS Member Boards. The physician must have participated in an approved QI Effort and have satisfied all of the participation requirements of the QI Effort. This attestation must also be “cosigned” (an electronic form is provided for this purpose) by the project leader, as determined by the Portfolio Sponsor. The completed and signed attestation will be retained by the Portfolio Sponsor who will notify the Portfolio Program of the physician’s completion of the QI Effort. Please note that participating ABMS Member Board MOC fees, if applicable, must be current and are the responsibility of each member physician, in order for the physician to receive MOC Part IV credit.