Personal Information

First name

Last name

Log in Information

Email

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Password 8 or more chars, at least 1 digit, 1 capital letter, and 1 of !,@,#,$,%,^,&, or *

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Provider Information

Occupation/Provider Type
Physician (including residents and fellows) Physician Associate (including residents and fellows) Nurse Practitioner (including residents and fellows)  Nurse Social Worker Other Mental Health Professional (LMFT; Licensed psychologist) Health professional student or trainee (Pre-Medical/Medical student or nursing student or etc.)  Clinic support staff Other

Do you have an NPI number? An NPI number will be required to complete the attestation required for providers seeking Medi-Cal payment. You can look up your NPI on CMS’ NPI Registry public search.
Yes No

Rendering National Provider Identifier (NPI) (Enter an accurate 10-digit NPI. This is for billing purposes). If no NPI, select No in previous question. (optional)

Organization Information

Organization Name

Zip/Postal code

Organization Type
Private Practice (Non-FQHC Clinic) Health System Hospital Medical Association Academic Institution Health Plan Federally Qualified Health Center (FQHC) Community-Based Organization (CBO) Indian Health Service Government Entity (Local/State/Federal) Medical Group Community/Public Health Clinic(s) Home Health Skilled Nursing Facility Other

Other Professional Information

Are you a Medi-Cal Billing Provider?
Y N

Are you currently screening for Dementia/Alzheimer's?
Y N

Needed for MOC Credit

Birthdate (optional)
January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

ABIM ID (optional)

Program Information

Which program are you here for? You will have access to courses from both programs.
Caregivers as Partners in Care Teams (CAP-CT) Dementia Care Aware (DCA)

What is your primary motivation for enrolling in this course?
I am looking to fulfill CE/CME or MOC credits My employer requires or incentivizes the completion of this course I want to enhance my knowledge or clinical skills to support my professional development I want to strengthen my patient-centered care skills I am drawn to the program because of its innovative content and evidence-based tools I want to learn about reimbursement opportunities (e.g. billing code 1494F) I am drawn to the course because of its feasibility (e.g. affordability or flexibility to fit my schedule) This course was recommended to me by a peer Other