<p> UVA Health System - Center for Organizational Development NetLearning Module Submission Form</p><p>NOTE: Before creating a NetLearning module, check this website to be sure one doesn’t already exist (or is “in progress”). http://www.healthsystem.virginia.edu/intranet/hrcod/cbl.html. Any module created by UVA staff may be shared with outside institutions.</p><p>Title of Module: Date Submitted: Requested Final Posting Date (please allow a minimum of 2 weeks) Author’s Name: Telephone #: Second Reviewer (Content Expert)’s Name: CBL Description (please write a one- to two-sentence blurb describing the module):</p><p>Test Information: Staff should be allowed to skip course content and go straight to test. Staff MUST review content before taking test. Each person may only attempt test once # of questions each person should get in post-test Test Questions will be assigned in: Random order In order submitted by author % required to pass the test</p><p>Posting Information: This module should be posted for “open enrollment” (i.e., available for anyone to enroll). This module will be pre-assigned to specific staff by job title. (NOTE: an Administrative User from the department will make this assignment.) This module needs to be assigned to all new hires to the Medical Center. This module is approved for CME or CEU credits from the CME office. This module is approved for VNA contact hours from HRCOD. Set to “standard” certificate. Make special certificate. Additional Information: When should this module be reviewed next, i.e., yearly (maximum is 36 months)?</p><p>DEPARTMENT/WORK AREA </p><p>Describe the educational need: (Include learner objectives)</p><p>Rationale/Validation of Need: Check all that apply</p><p> the patient population served findings from: ______information from QI (attach QI findings) advances in health care management needs assessment (attach tool and summarized results) regulatory agencies requirements department/service performance appraisals of individuals peer review hospital's plant, technology, or safety management programs infection control activities (attach any pertinent data) other </p><p>Describe specifically the target audience who would participate in the educational intervention. </p><p>Plan:</p><p>Describe how target audience input was considered in relation to content, location, and scheduling:</p><p>D:\Docs\2017-12-16\084cc06f9bbdcb47424386277147930b.doc, 2/24/06</p>