Please review
OAR 855-135-0030 for information related to applications for approval. Please note that a provider must submit an application form a
minimum of 45 days prior to the date the program will be held. Applications received less than 45 days prior to the date the program will be held will not be approved.
Please note that the OBOP CPE Application form is currently having issues and has been temporarily removed.
To submit a CPE Program for approval, please email the following information including a sample certificate to pharmacy.ce@bop.oregon.gov:
First & Last Name of Contact Person Completing this Application: (required)*
Contact Email: (required)*
Contact Phone Number: (required)*
Program Provider or Sponsor Name:
Program Name: (required)*
Select a Program Topic Designation: (*required)
Topic 01: Pharmacy Law
Topic 02: Patient Safety / Medication Error Prevention
Topic 03: Cultural Competency
Topic 04: Other in Subjects Pertinent to Pharmacy
Total number of contact hours offered by topic designation*: (required)*
*Note: 60 minutes = 1 hour of CPE
Anticipated Participants (choose an option(s) below): *required
Pharmacist
Intern
Certified Oregon Pharmacy Technician or Pharmacy Technician
Type of Course (choose an option below): *required
Single Offering
Multiple Offering
Program Format Type (choose an option below): *required
Speaker
Panel
Other *
If "Other", explain:
Course Delivery Method (choose an option below) *required
In Person: Live
Online: Live
Online: Self-paced
Hybrid: *
If "Hybrid", explain:
Course Date(s):* (required)*
month/day/year
Course Location (select an option below) *required
Online
Address:
City:
State:
OR
Zip Code:
Note: One Instructor must be a Pharmacist if Intern(s) are listed as an Instructor.
Instructor 1:
Instructor First & Last Name: (required)*
Instructor License Number: (required)*
Statement of how this Instructor is qualified to present the content: (required)*
Please review OAR 855-135-0040 - Is the Instructor requesting two hours of CPE credit for each hour spent in presenting the course? (required)*
Choose either "yes" or "no"
Yes
No
Is the Instructor's primary responsibility the education of health professionals? (required)*
Choose either "yes" or "no"
Yes
No
Provide a description of the program (1-2 sentences): (required)*
1 -2 sentences
List learning objectives (minimum of 3) :
Objective 1: (required)*
Objective 2: (required)*
Objective 3: (required)*
Additional Objective(s):
Provide the program content assessment questions (minimum one question per learning objective): *required
Program Content Assessment Question 1: (required)*
Program Content Assessment Question 2: (required)*
Program Content Assessment Question 3: (required)*
Additional Program Content Assessment Questions (if applicable):
Explain how you will have participants evaluate the program: (required)*
Attestation: On behalf of the program provider or sponsor, I agree that the CPE program requested meets the Oregon Board of Pharmacy requirements for Continuing Pharmacy Education as stated in OAR 855-135. I attest that the information provided is true and accurate and the program provider or sponsor will ensure that any licensees issued CPE credit under this approval attended the entire program and will be provided with a certificate of completion. See OAR 855-135-0010(4) for certificate requirements.
First & Last Name: (required)*
Email Address: (required)*
Today's Date: (required)*
month/day/year
Attach a sample Certificate of CPE completion. All sample certificates must contain each requirement as listed in OAR 855-135-0010(4)(a-f) and must be attached in PDF format.