PXE Application to Offer Credits

This application is for organizations seeking approval to offer Patient Experience Education (PXE) credits for a program or event.

To complete this application, you will need:
-Program title
-Program description
-Program agenda
-Learning objectives
-Presenter information including short bio

Application Review Timeline
Please allow 10–14 business days for review of complete PXE applications. Incomplete applications may delay processing.

Applications should be submitted at least 30 days prior to the event date to ensure standard review timelines. Expedited review may be available and is subject to an additional fee. Contact pxu@theberylinstitute.org with questions.

PXE Application to Offer Credits

For organizations seeking approval to offer Patient Experience Education (PXE) credits for a program or event.

SECTION 1: ORGANIZATION & PROGRAM OVERVIEW

Organization Name(Required)

Primary Contact Name(Required)

First Last

Primary Contact Email(Required)

Program / Event Title(Required)

Program Description (brief, non-promotional)(Required)

Program/Event Website

SECTION 2: PROGRAM FORMAT & STRUCTURE

Program Format(Required)

Other format:

Program Date(s)(Required)

SECTION 3: PXE CREDIT REQUEST & ISSUANCE METHOD

Number of PXEs Requested

PXEs are calculated based on instructional time. One (1) PXE equals 60 minutes of educational content, and credits may be awarded in 30-minute increments (0.5 PXE). Count each educational session or breakout separately and include only instructional time; do not include breaks, meals, or networking activities.

Has this event been approved for credits by other accrediting bodies?(Required)

Yes

Upload Continuing Education Approval Documentation

Max. file size: 50 MB.

Please upload a copy of the official approval notification or certificate issued by the accrediting body.

PXE Issuance Method(Required)

Your organization will issue certificates directly to participants

Participants complete a Beryl Institute survey and receive a PXE Statement of Credit

SECTION 4: PROGRAM AGENDA - CONFERENCE/MULTI-SESSION EVENTS

If your program is a conference or multi-session event, please provide a link to or upload the program agenda.

Program Agenda Link

Program Agenda Upload

Max. file size: 50 MB.

SECTION 5: EDUCATIONAL DESIGN

This section is required for single programs (e.g., webinar, course, workshop). You must have at least 1 educational objective.

Educational Objective 1

Objective

Educational Objectives: List an educational objective in learner oriented outcomes and measurable behavioral terms, i.e., “By the end of this presentation the participant will be able to:”

Content Outline/Teaching Strategies

Content Outline/Teaching Strategies: Provide a brief outline of the content being presented to address the objective. Describe the teaching methods and learner engagement strategies that will be used.

Time Frame

Provide a time frame for each objective and its related content. The number of minutes for each educational objective should total the number of minutes allotted for the program/event.

Speaker(s)

List the presenter(s) for the topic area.

Educational Objective 2

Objective

Content Outline/Teaching Strategies

Time Frame

Speaker(s)

Educational Objective 3

Objective

Content Outline/Teaching Strategies

Time Frame

Speaker(s)

Educational Objective 4

Objective

Content Outline/Teaching Strategies

Time Frame

Speaker(s)

Additional Objectives (if applicable)

SECTION 6: PRESENTER INFORMATION

This section is required for single programs (e.g., webinar, course, workshop). Please provide the following information for all presenters.

Presenter 1 - Name and Credentials

Presenter 1 - Title

Presenter 1 - Organization

Presenter 1 - Short Bio

Presenter 2 - Name and Credentials

Presenter 2 - Title

Presenter 2 - Organization

Presenter 2 - Short Bio

Presenter 3 - Name and Credentials

Presenter 3 - Title

Presenter 3 - Organization

Presenter 3 - Short Bio

Presenter 4 - Name and Credentials

Presenter 4 - Title

Presenter 4 - Organization

Presenter 4 - Short Bio

Conflict of Interest Disclosure Requirement

Each presenter listed in this application will be required to complete an online Conflict of Interest Disclosure Form. The form will be provided to the primary contact following initial review of the PXE application. Approval will not be finalized until all required disclosure forms are submitted.

SECTION 7: FINAL ACKNOWLEDGEMENTS

By submitting this application, I acknowledge:

The educational content described is non-promotional and focused on patient experience education.

All information submitted is accurate and complete.

I understand that PXE approval is not final until all required materials and disclosures are reviewed and approved.