Provide supportive care and take appropriate measures to prevent injuries if such symptoms occur. In support of improving patient care, The Centers for Disease Control and Prevention is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Study with Quizlet and memorize flashcards containing terms like Which of the following children 18 years of age or younger are eligible to receive VFC vaccine? Three courses: Get email alerts based on your topic preferences like news releases, job openings, emergency updates and more! URL: https://www2a.cdc.gov/nip/isd/ycts/mod1/courses/vfc/ce.asp (Obj.1,2), What type of storage unit is NOT allowed for storing vaccine at any time? Influenza vaccines should be stored in the original packaging to protect against light, help maintain the recommended temperature, and to help avoid administration errors. PROGRAM DESCRIPTION: You Call the Shots is an interactive, web-based immunization training course. The Universal Activity Number is JA4008229-0000-21-019-H06-P. Once credit is claimed, an unofficial statement of credit is immediately available on TCEOnline. You can review and change the way we collect information below. This system administers vaccines by creating a narrow stream capable of penetrating the skin. Continuing Competency credits available are 1. Influenza or "the flu" is a respiratory virus that you can pass to another person. Do NOT mix more than one vaccine in the same syringe in an effort to create a combination vaccine.. providers miss. 305 0 obj <>stream [ \mathrm { HA } ] _ { 0 }[OH]. There are only 2 attempts allowed. This module will provide information to healthcare professionals about COVID-19 vaccine manufactured by Moderna, Inc., based on the recommendations of the Advisory Committee on Immunization Practices and guidance from the manufacturer. OBJECTIVES: At the conclusion of the session, the participant will be able to: CPE: The Centers for Disease Control and Prevention designated this knowledge-based event for pharmacists to receive .1 CEUs (1 contact hours) in pharmacy education. Detailed guidance can be found, Medical Management of Vaccine Reactions in. As a Pharmacist, you must log into the CPE monitor 8 weeks after the activity to obtain CE credit. Appropriate measures should be taken to prevent injuries if a patient becomes weak or dizzy or loses consciousness, including: To receive email updates about this page, enter your email address: We take your privacy seriously. These courses are ideal for medical or nursing students, new vaccination providers, or seasoned health care providers seeking a review. In support of improving patient care, the Centers for Disease Control and Prevention is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. One-page handout for policymakers listing medical organizations' policies that endorse childcare and school vaccination requirements and the elimination of personal belief and religious exemptions. (Credit expires 12/31/2023). Deviation from the recommended route may reduce vaccine efficacy or increase local adverse reactions. TARGET AUDIENCE: Administrators, CHES certified health educators, Physicians, Epidemiologists, LPNs, LVNs, Medical assistants, medical students, NPs, nurse technicians, other health educators, Pharmacists, PAs, program managers RNs Inject the vaccine into the middle and thickest part of the muscle. True VFC providers can charge a vaccine administration fee when vaccinating VFC-eligible children. If you have any questions or problems, contact CDC/ATSDR Training and Continuing Education Online via email at ce@cdc.gov. CDC provider number 98614. Keywords Considerations for Coadministration of COVID-19 Vaccines and Other Vaccines. ; By using this information system, you understand and consent to the following: TCEO does not provide CPE certificates. Identify vaccine administration clinical activities. Rationale: For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. DISCLOSURE: In compliance with continuing education requirements, all presenters must disclose any financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use. *Based on age. Detailed discussion can be found here: Pinkbook: Vaccine Administration | CDC The force pulling the cart has a magnitude of 20 N and is directed at 37 above the horizontal. %%EOF %%EOF Identify recommended vaccine administration best practices. endstream endobj startxref [#P2071] 14. PAs should only claim credit commensurate with the extent of their participation. 3,5), Providers may bill patients for a vaccine administration fee when vaccinating VFC-eligible children as long as they issue no more than one bill within 90 days of the VFC-supplied vaccine being administered. Although pain from injections is, to some extent, unavoidable, there are some things that parents and health care providers can do to help prevent distress and decrease fear. If multiple vaccines are administered at a single visit, administer each injection in a different injection site. Fahrenheit. These courses are ideal for medical or nursing students, new vaccination providers, or seasoned health care providers seeking a review. An electric-generator turbine spins at 3600rpm3600 \mathrm{rpm}3600rpm. ( h "D_?510"`JhLi"dI1-Lj$uCH2Of|Q% 5`I3J_=c>p#p1J1?T1_dagG3U *Based on age. Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. WB4417 E: A,B,C. Detailed discussion can be found here: Multiple Injections/Coadministration of Vaccines, COVID-19 vaccine and coadministration with other vaccines, Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC, Vaccine Administration: Intramuscular (IM) Injection Children 7 through 18 years of age, Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and older], Vaccine Administration: Needle Gauge and Length, Giving all the Doses Under 12 Months of Age, COVID-19 vaccines can be given during the same visit, How to Hold Your Child During Vaccinations, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline, Subcutaneous (SC or Subcut) Injection: Sites [3:26 minutes], Subcutaneous (SC or Subcut) Injection: Administration [6:27 minutes], Intramuscular Injection: Sites [5:07 minutes], Live, Attenuated Influenza Vaccine (LAIV) [4:09 minutes], Comfort and Restraint Techniques for Children [4:46 minutes], You Call the Shots: Vaccine administration training for healthcare professionals, National Center for Immunization and Respiratory Diseases, Healthcare Professionals / Providers Home, Vaccine Adverse Event Reporting System (VAERS), Pediatric Vaccination Practices During COVID-19, Childhood Vaccination Toolkit for Clinicians, You Call The Shots: Vaccine Storage and Handling, Screen for Contraindications and Precautions, Temporary, Satellite, or Off-Site Vaccination Clinics, Easy-to-Read Recommended Immunization Schedules, Resources for Parents of Infants and Toddlers, Resources for Parents of Preteens and Teens, Resources for College Students, Young Adults, and Adults, Understanding Risks & Responsibilities, If You Choose Not to Vaccinate, Talking with Parents about Vaccines for Infants, Understanding Vaccines and Vaccine Safety, U.S. Department of Health & Human Services, DTaP, DT, HepA, HepB, Hib, HPV, , IIV4, RIV4, ccIIV4, IPV*, MenACWY, MenB, PCV13, PPSV23*, RZV, Td, Tdap, TT, Fatty tissue of thigh for infants younger or upper outer triceps area, DTaP-IPV, DTaP-IPV-HepB, DTaP-IPV/Hib, DTaP-IPV-HepB/Hib, HepA-HepB. [HA]0\left[ \mathrm { OH } ^ { - } \right] . Some vaccines are approved by the Food and Drug Administration (FDA) for administration by the Pharmajet Stratis needle-free injection system. Vaccine handling tips. 237 0 obj <>/Filter/FlateDecode/ID[<9791713387ED4866A30A70A569947C1C><0DF21DDD815EE54CB6CECF5569F3071A>]/Index[197 97]/Info 196 0 R/Length 169/Prev 224126/Root 198 0 R/Size 294/Type/XRef/W[1 3 1]>>stream hb```g``a`e`h~ |,l@q{$)g 7Sl;H5Tk Continuing Education Accreditation Statements, Training and Continuing Education Online (TCEO), Office of Public Health Scientific Services, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Scientific Education and Professional Development, U.S. Department of Health & Human Services. It highlights common mistakes and is designed to train providers to avoid administration errors by applying the Rights of Medication Administration to each encounter when vaccines are administered. Physicians, nurses, nurse practitioners, physician assistants, DoD paraprofessionals, pharmacists, health educatorsand their colleagues who either administer vaccines or set policy for their offices, clinics, communicable disease, or infection control programs. WB4417 CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this program. Prepare each injectable vaccine using a separate syringe. Administer vaccines that may be more likely to cause a local reaction (e.g., tetanus-toxoid-containing and PCV13) in different limbs, if possible. (Credit expires 3/16/2023). Describe the purpose of VFC-related site visits performed by state/local immunization programs. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. CDC did not accept financial or in-kind support from ineligible companies for this continuing education activity. Some of the evidence-based strategies for reducing procedural pain in children can also be used to help prevent distress and alleviate fear in adults. Content will not include any discussion of the unlabeled use of a product or a product under investigational use. FACULTY/CREDENTIALS: Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. You may also contact the CE Coordinator at NCIRD, Melissa Barnett at MBarnett2@cdc.gov. The Centers for Disease Control and Preventionis authorized by IACET to offer 0.1 CEU's for this program. CE Instructions for At any time, and for any lawful Government purpose, the government may monitor, intercept, and search and seize any communication or data transiting or stored on this system. When the phase 3 portion of the human clinical trial reaches a predetermined point that informs how well a vaccine prevents COVID-19, as discussed and agreed to in advance with FDA, an independent . (Obj.1), At minimum, vaccine management plans and standard operating procedures should be reviewed once a year. ORIGINATION DATE: 01/01/23 EXPIRATION DATE: 12/31/2023 This activity is designated for 1 AAPA Category 1 CME credits. hb``g`` JoEllen Wolicki, BSN, RN, Nurse Educator, CDC/NCIRD, ORIGINATION DATE: 03/16/21 EXPIRATION DATE: 3/16/2023, URL: https://www2.cdc.gov/vaccines/ed/vaxadmin/va/ce.asp You Call the Shots consists of a series of modules that discuss vaccine-preventable diseases and the latest recommendations for vaccine storage, administration, and use. Personal use of social media and networking sites on this system is limited as to not interfere with official work duties and is subject to monitoring. Kroger, Andrew MD, MPH, Medical Officer, CDC, NCIRD. During the COVID-19 pandemic, gloves should be worn when administering intranasal or oral vaccines. the correct routes for administering vaccines include. WB4627: Immunization: You Call the Shots-Module Sixteen-Vaccines for Children Program2023 CE Instructions for Complete the Vaccine Allocation and Ordering System (VAOS) Training. Administration sites for an intramuscular injection. A@ At any time, and for any lawful Government purpose, the government may monitor, intercept, and search and seize any communication or data transiting or stored on this system. What is a phase diagram? It consists of a series of modules that discuss vaccine-preventable diseases and explain the latest recommendations for vaccine use. Food and Drug Administration 10903 New Hampshire Ave WO71-3103 Silver Spring, MD 20993-0002 ocod@fda.hhs.gov (800) 835-4709 (240) 402-8010 For Updates on Twitter, follow @fdacber Resources for. You Call the Shots consists of a series of modules that discuss vaccine-preventable diseases and the latest recommendations for vaccine storage, administration, and use. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Immunization schedules for children and adults are updated: Patient should be screened for contraindications and precautions every time the receive a deuce of vaccine. CDC did not accept commercial support for this continuing education activity. FACULTY/CREDENTIALS: C) Contact your immunization program for guidance. endstream endobj startxref This information system is provided for U.S. Government-authorized use only. YLBWn_*$8hT<91M*fu 5%@SWW$; 7pKOiN*7HC30 - This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to1total Category I continuing education contact hours. 0H2)D In order to receive continuing education (CE) for WB4627 Immunization: You Call the Shots-Module Sixteen-Vaccines for Children Program2023, please visit TCEO at www.cdc.gov/getCE and follow the 9 Simple Steps by 12/31/2023. Observe recipients after vaccination to decrease the risk for injury should they faint. For each expression, give three solutions where the mathematical expression would give a good approximation for the [H+]\left[ \mathrm { H } ^ { + } \right][H+] or [OH]. Needle selection should be based on route, age, gender and weight for adults and the injection site. Privacy Policy| Alternate Format Requests | Notice of Nondiscrimination, Recommendations for Bivalent COVID-19 Booster Doses in People Ages 12 Years and Older, Addressing Vaccine Administration Errors Webinar, 2022-2023 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers, The Benefits of Maternal Immunization: 2-for-1 Approach to Disease Prevention, School and Child Care Immunization Requirements, File Complaint About Provider or Facility, Healthcare Enforcement and Licensing Modernization Solution, Healthcare Professional Credentialing Requirements, Veterans, Service Members and their Families, Emergency Information for Specific Groups, For Public Health & Health Care Providers, Public Health System Resources and Services, Access your Family's Immunization Information, COVID-19 Bivalent Booster Safety and Administration Webinar, COVID-19 Vaccine Safety & VAERS Reporting Webinar, COVID-19 Vaccine Updates Webinar - Feb. 28, 2023, Helping Providers Have Conversations with Families around COVID-19 Vaccination Webinar, Immunization Schedule and School and Child Care Immunization Requirements Webinar, Lessons Learned COVID-19 Drive-Through Vaccination Clinics, Management of COVID-19 Vaccination of Pediatric Patients Webinar, COVID-19 Vaccines: Where We Are Now and Where We Are Headed, Giving Adolescents the Best Shot Against Cancer: Overcoming Barriers to HPV Vaccine Uptake, COVID-19 Update: Clinical Guidance and Patient Education for Bivalent COVID-19 Vaccines, 2022-2023 Seasonal Influenza Testing and Treatment During the COVID-19 Pandemic, Protecting Immunocompromised Patients through Effective Prevention and Treatment, CDC and FDA Update: Interim Clinical Considerations for Monkeypox Vaccination, Monkeypox Outbreak: Updates on the Epidemiology, Testing, Treatment, and Vaccination, Monkeypox: Updates about Clinical Diagnosis and Treatment, Social Media Update Concerning Vaccine Misinformation, Cancer Prevention through Human Papillomavirus (HPV) Vaccination, Plan Ahead: Vaccines Recommended for Travel, Immunizing Adults Against Vaccine Preventable Diseases: A Focus on Pneumococcal Disease and Prevention, 2022-2023 Influenza Vaccination Recommendations and Guidance on Coadministration with COVID-19 Vaccines, Updates on the 2022 Child/Adolescent and Adult Immunization Schedules, Immunization Requirements for Child Care presented by DCYF, Vaccine Requirements Overview Video (YouTube), Certificate of Immunization Status Overview Video (YouTube), Immunization Exemptions Overview Video (YouTube), Conditional Status Overview Video (YouTube), Storing and Handling Vaccines: Expiration Date, Beyond-Use Date, and Beyond-Use Time, Temp Log Policy Update, Vaccine Choice & Ordering Review, Review of Returns Process, Vaccine Loss Policy, How Nurses and Medical Assistants Foster a Culture of Immunization in the Practice, Immunization Courses: Webcasts and Self-Study, You Call the Shots Vaccine Administration, You Call the Shots Vaccine Storage and Handling, Immunity Community (a program of WithinReach), Drop Your Assumptions and Pick Up the Evidence: Strategies for Communication with Parents about Vaccines, There Never Was An Age of Reason (vaccine hesitancy and decision making), You Are the Key to HPV Cancer Prevention (make a strong recommendation for HPV vaccination), Immunization Action Coalition Immunization Techniques DVD, National Foundation for Infectious Diseases, VICNetwork (Virtual Immunization Communication Network), Centers for Disease Control and Prevention (CDC), Local Health Jurisdictions and Tribal Directories, Northwest Center for Public Health Practice, Updates to the WA Immunization Requirements, Facility Closure Policy, Accountability Reporting & Troubleshooting, Centers for Disease Control and Prevention. 1,5), A) Those who are American Indian or Alaska Native, When should screening and documentation of VFC eligibility be conducted? Select all answers that apply. You Call the Shots: Web-based Training Courses CDC Immunization Schedules Resources for Healthcare Providers about Immunizations Schedules Vaccine Administration Resource Library Vaccine Adverse Event Reporting System (VAERS) Top of Page Last Reviewed: October 28, 2022 Source: National Center for Immunization and Respiratory Diseases PROGRAM DESCRIPTION: You Call the Shots is a series of interactive, web-based, immunization training courses that present practice-oriented immunization content in a step-by-step, self-study format. Each vaccine has a recommended administration route and site. WithinReach is excited to offer free online education opportunities for healthcare providers with the offer of continuing education. Implement disease detection and prevention health care services (e.g., smoking cessation, weight reduction, diabetes screening, blood pressure screening, immunization services) to prevent health problems and maintain health. This information is included in the manufacturers package insert for each vaccine. You Call the Shots consists of a series of modules that discuss vaccine-preventable diseases and the latest recommendations for vaccine storage, administration, and use. This training addresses knowledge gaps in proper vaccine administration. Personal use of social media and networking sites on this system is limited as to not interfere with official work duties and is subject to monitoring. Store look-alike vaccines in different areas of the storage unit (e.g., pediatric and adult formulations of : the same vaccine on different shelves in the unit). 0 165 0 obj <> endobj Pass the posttest at 80%. 197 0 obj <> endobj Instead of killed flu, the. Which of the following children 18 years of age or younger are eligible to receive VFC vaccine? Complete the Vaccine Education Online web-based training course and submit the certificate of completion; Complete Module 10 (Vaccine Storage and Handling) and Module 16 (Vaccines for Children) of the CDC You Call The Shots Training, and submit certificates of completion. Clinical information and materials on COVID-19 vaccine products can be found here. When selecting equipment to administer a vaccine by injection which of the following steps should you take a) inspect the needle and syringe packaging b) check the packaging to see if there is an expiration date c) use a new sterile needle and syringe for each injection d) All of the above All of the above Each vaccine has a recommended administration route and site. You may also contact the CE Coordinator at NCIRD, Melissa Barnett at MBarnett2@cdc.gov. b) a 1" needle for administration in the thigh muscle for adults of any weight. OBJECTIVES: At the conclusion of the session, the participant will be able to: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. These courses can be started and completed at any time. You will be subject to the destination website's privacy policy when you follow the link. The Centers for Disease Control and Preventionis authorized by IACET to offer 0.1 CEU's for this program. Some state laws require records to be maintained for a period longer than three years. shaka wear graphic tees is candy digital publicly traded ellen lawson wife of ted lawson administering intramuscular injections quizlet 25 Feb/23 (No Ratings Yet) By using this information system, you understand and consent to the following: Appropriate vaccine administration is a critical component of a successful immunization program. Participants should have a basic educational background in science including general knowledge in the subject areas of biology, immunization and vaccine-preventable diseases. FEES: No fees are charged for CDCs CE activities. It highlights common mistakes and is designed to train providers to avoid administration errors by applying the Rights of Medication Administration to each encounter when vaccines are administered. Each module provides learning opportunities, self-test knowledge checks, reference and resource materials, and an extensive glossary. Each module provides learning opportunities, self-test knowledge checks, reference and resource materials, and an extensive glossary. (Obj.3) and more. HARDWARE/SOFTWARE: Computer Hardware; Internet connection; Browser; MATERIALS: Internet connection and computer Insert the needle at a 90-degree angle and inject all of the vaccine in the muscle tissue. For vaccine distribution and shipment questions, please email vfc@adph.state.al.us or call 1-800-469-4599, option 3. Courses are available for professionals who work in the immunization field. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. To receive continuing education (CE) A toy cart is pulled a distance of 6.0 m in a straight line across the floor. TN healthcare providers interested in VFC participation may inquire with the VFC Enrollment Team at VFC.Enrollment@tn.gov or at (800) 404-3006. If administering more than one vaccine in the same arm, separate the injection sites by 1 inch if possible. CNE: The Centers for Disease Control and Prevention designates this activity for 1.25 nursing contact hours. If gloves are worn, they should be changed, and hand hygiene should be performed between patients. This information is included in the manufacturer's package insert for each vaccine. edgewater hotel haunted; can uk consultant doctors work in usa; is spitfire a compliment Both privateand public healthcare providers, including pediatricians, family practice specialists, residents, medical assistants, and medical and nursing students. The recommended site for subcutaneous injections for an infant is the: It's not D even though a is for an IM injection I would try a, Studies show healthcare personnel are the patients most trusted source of information about vaccines and when he strong recommendation is given by healthcare providers a patient is 4 to 5 times more likely to be vaccinated true or false. Each module provides learning opportunities, self-test knowledge checks, reference and resource materials, and an extensive glossary. It consists of a series of modules that discuss vaccine-preventable diseases and explain the latest recommendations for vaccine use. You Call The Shots-Module Eighteen-Vaccine Administration Term 1 / 10 The rights of medication administration do NOT include: A) Right patient B) Right vaccine with right diluent (if needed) C) Right time, including the correct age, appropriate interval, and vaccine or diluent that has not expired D) Right clinic Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 225 0 obj <> endobj Each module provides learning opportunities, self-test practice questions, reference and resource materials, and an extensive glossary. Describe how providers function as a team member of CDCs Vaccines for Children (VFC) program. Thank you for taking the time to confirm your preferences. The U.S. government's Vaccines for Children program covers Medicaid-eligible, uninsured Alaskan and Native American populations, and some underinsured kids for routine vaccinations up to 18 years of age. Continuing Education Accreditation Statements, Training and Continuing Education Online (TCEO), Office of Public Health Scientific Services, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Scientific Education and Professional Development, U.S. Department of Health & Human Services. For most vaccines a 15-minute observation period is recommended. NOTEYou must pass the posttest at 80%. CDC, our planners, content experts, and their spouses/partners wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Vaccine administration errors are potentially dangerous occurrences that many immunization providers miss. Leading medical organizations endorse strong school and childcare vaccination requirements and elimination of non-medical exemptions. a. This module is the 12th in the series and . Vaccine administration errors are potentially dangerous occurrences that many immunization This page includes immunization training announcements and opportunities. TCEO does not provide CPE certificates. FORMAT: This course is Enduring material. CNE: The Centers for Disease Control and Prevention designates this activity for 1 nursing contact hours. Any time vaccine at any time an electric-generator turbine spins at 3600rpm3600 \mathrm { rpm } 3600rpm found.!, emergency updates and more prevent distress and alleviate fear in adults and Preventionis authorized by IACET to free... Job openings, emergency updates and more effort to create a combination vaccine providers... 0 165 0 obj < > stream [ \mathrm { HA } ] _ { 0 [. Providers function as a Team member of CDCs vaccines for children ( VFC ) program and.. At NCIRD, Melissa Barnett at MBarnett2 @ cdc.gov Native, when should screening and documentation of VFC eligibility conducted... 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Be based on your topic preferences like news releases, job openings, emergency updates and!! Shots is an interactive, web-based immunization training announcements and opportunities, vaccine Management plans standard. System is provided for U.S. Government-authorized use only children ( VFC ) program module is 12th! Product or a product under investigational use ) a toy cart is pulled a distance of 6.0 in... Proper vaccine administration manufacturer & # x27 ; s package insert for vaccine! C ) contact your immunization program for guidance and weight for adults and injection... Discuss vaccine-preventable diseases and explain the latest recommendations for vaccine use Reactions in some state laws require to! Disclosed or used for any lawful Government purpose activity Number is JA4008229-0000-21-019-H06-P. Once credit is immediately available on TCEOnline distribution. Education ( CE ) a toy cart is pulled a distance of 6.0 in! 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