Note: Before beginning the MOC Part IV process, diplomates need to enroll in ACPM's MOC Part IV Process.

Enrolled diplomates will download the Diplomate Practice Assessment Plan (DPAP) (view sample) and Diplomate Practice Assessment Plan (DPAP) instructions (view) that will walk you through the seven-step process of MOC IV: Practice Performance Assessment.

1. Selection of evaluation tool for performance assessment

2. Preparing for the evaluation

3. Completion of selected evaluation tool

4. Identify target areas for improvement

5. Quality improvement plan development

6. Measurement of improvement

7. Submission of Documentation

Clinical Practice Evaluation: You must select this tool if greater than 10% of professional time is spent providing direct patient care) chart-review based evaluation of application of USPSTF/other accepted standard of care for preventive screening and population health within clinical practice AND clinical systems review.

Clinical Practice Evaluation I (select Adult or Pediatric)

Adult - Medical Record Review

• Instructions

• Form SAMPLE
  

Pediatric - Medical Record Review

• Instructions

• Form SAMPLE
  

Clinical Practice Evaluation II - Clinical System Review

• Instructions

• Form SAMPLE
  

-OR-

360-Degree Feedback Evaluation: Compilation of feedback regarding fulfillment of selected competencies in a rating scale format from self, superiors, peers and subordinates

Feedback Evaluation Form Instructions

Feedback Evaluation Form SAMPLE

Report Card Evaluation

narrative-style self-assessment and feedback from supervisor regarding fulfillment of selected competencies. Note:If you would prefer to use your workplace evaluation, please choose the portfolio-style assessment and include as evidence.

Report Card Evaluations Instructions
Report Card Evaluations SAMPLE

Portfolio Evaluation

Compilation of CV and diplomate-selected products/examples from practice representing fulfillment of selected competencies

Portfolio Card Evaluations Instructions
Portfolio Card Evaluations SAMPLE

To enroll in the American College of Preventive Medicine MOC Part IV process, you need to complete the registration below. Once you have registered and paid your MOC Part IV Fee ($295 members/$395 non-members). You will be able to download your DPAP and the Part IV tool of your choice.

ENROLL NOW 

If at any point you would like to switch tools or have any questions, please contact hbarno@acpm.org or call (202) 466-2044 x103.You may submit your application electronically or via mail, electronic submissions will be processed faster.

Electronic submissions can be sent to: hbarno@acpm.org

Mail submissions should be sent to: 

American College of Preventive Medicine ATTN: MOC Part IV,

455 Massachusetts Ave., NW, Suite 200, Washington, DC, 20001

Once submitted, your work will be forwarded to the CME/MOC committee for review, if approved the completion of the MOC IV: Practice Assessment will be forwarded to the American Board of Preventive Medicine.

For more information, contact barno@acpm.org.

Already started the process?

If you have started your MOC Part IV process with previous version of the ACPM MOC Part IV tool, you may continue and complete them.  Diplomates using previous Part IV tools are required to notify ACPM by emailing hbarno@acpm.orgthe following information:

• First/Last Name
• Type of Tool
  
• Certification Year
• ACPM Membership Status (Member/Non-member)
• Expected Date of Submission
• Payment Information
  

When to submit

MOC Part IV reviews are rolling and can take 6-8 weeks. Once your review is completed, you will receive a notification email and if completion is successful a record will be sent directly to the American Board of Preventive Medicine