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The Case Management Society of Australia and New Zealand and Affiliates
(CMSA) Certification sets the benchmark of excellence in case management.
Certified Practising Case Managers™ (CPCM) and Certified Case Managers
(Non Practising)™ (CCMNP) adhere to the CMSA National Standards and
National Code of Ethics for Case Management and are recognised for their
advanced education, experience, knowledge and skills by their colleagues,
consumers and employers.
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The Case Management Society of Australia and New Zealand and Affiliates (CMSA) Certification sets the benchmark of
excellence in case management. Certified Practising Case Managers™ (CPCM) and Certified Case Managers (Non Practising)™
(CCMNP) adhere to the CMSA National Standards and National Code of Ethics for Case Management and are recognised for
their advanced education, experience, knowledge and skills by their colleagues, consumers and employers.
COPYRIGHT © 2017 Case Management Society of Australia and New Zealand and Affiliates (CMSA)
Attachment 10 - Re-endorsed Certified Case Manager™ - Professional Training and Development (PTD) Form - Page 1 of 2
RE-ENDORSED CERTIFIED CASE MANAGER™ - PROFESSIONAL TRAINING & DEVELOPMENT
FORM
TO THE APPLICANT
The information being sought in this form is for the
purpose of verifying your 24 hours of Professional Training
and Development (PTD) undertaken in the last 3 years and
backdated from the date of your previous endorsement (i.e.
registration date) as a Certified Case Manager™ by the
CMSA. Activities undertaken must be related to Case
Management and specific to your practice area/role as it
relates to case management (practical, managerial or
theoretical). Instructions for completing this form along with
full details of approved PTD activities are available online at
www.cmsa.org.auPlease go to [Navigation tab] Certification
[Drop down menu] Applying To Be Certified / Professional
Training & Development Activities Explained.
As part of the CMSA’s ongoing Quality Assurance of
Certified Case Managers™ it is important that you
understand that the Society will conduct random audits of
Certified Case Manager™ re-endorsement applications
and accordingly you may be contacted by a representative
of the CMSA seeking evidence of the information you
have claimed within this form. If you are audited you will
be given 28 days from the date of notice by the CMSA to
submit evidence of your PTD activities.
Please complete, print and sign this form. All content
must be typed into this form. Handwritten versions of the
form will not be accepted by the CMSA.
Applicant details:
Title
(Prof, Dr, Mr, Mrs, Ms.):
SURNAME:
GIVEN/FIRST name:
PTD Activity details:
Please number each activity (ie. 1,
2 etc) and label your responses to
questions (a) – (f) below (e.g. 1a,
1b, 1c, 1d, 1e & 1f and 2a, 2b, 2c,
2d, 2e and 2f etc)
(a) Title of PTD activity:
(b) Date of PTD activity:
(c) Presenter/company:
(d) Description of PTD activity:
(e) Supporting evidence of the
PTD activity:
(f)Total time (hr/min) of activity:
EXAMPLE ONLY