MOC Progress Form

  • This is where you will track your progress towards certification. You can work at your own pace, you do not have to complete all of the steps in one sitting.

    As you complete the steps below, be sure to check the box so that we can be notified of your progress.

    Each time you check a box, click the "Save and Continue" link at the bottom of this page.

    Once you've completed all sections, click "Submit" to notify us that you are done.

    If you have any questions, contact project manager Lori Lovett at or (317) 374-0327.

  • You'll start by talking to the project leader, Lori Lovett. She can be reached at 317-374-0327 or by email at Once you've touched base with Lori, mark this task complete and move to the HPV Pre-Test.

    Due Date: At start of project.

  • Start the HPV Pre-Test

    Due Date: At start of project.

  • The Indiana Immunization Coalition's HPV Provider Resource Tool Kit is the educational component for the project. The Tool Kit provides best practice information from the Centers for Disease Control and Prevention and the American Academy of Pediatrics. The Tool Kit provides strategies for talking with families about HPV and the vaccine and provides patient education materials as well.

    You can obtain the HPV Tool Kit the following ways (you must be logged in to access):  

    • Order a printed binder. Click here to order.
    • Order a flash drive. Click here to order.
    • Download individual items from the tool kit. Click here to download.
    Once you've reviewed the Toolkit you can start filling out your daily tracking log.  

    Due Date: At start of project.

  • In order to complete the project, you will be logging the number of patients (males and females, ages 11-21) who you see each day who are eligible for the first dose HPV vaccine and also the number of patients who actually receive the vaccine. Use this form to track this data for six consecutive months. In addition, note on the Daily Tracking Log any strategies that worked or didn't work in terms of recommending the vaccine.

    Fill out the Daily Tracking Log online
    Download the Daily Tracking Log

  • Please visit to review these required Quality Improvement Modules:
    1. Quality Improvement (6 parts)
    2. Readiness Assessment and Developing Project Aims (7 parts)
    3. Performance Management and Measurement (3 parts)

    Due Date: By end of project.

  • Quality Improvement Post Test

    Due Date: By end of project.

  • Click here to take the HPV Post Test HPV Post Test

    Due Date: By end of project.

  • To access the attestation form, log into your individual portfolio on the American Board of Pediatrics website. Download the form, complete it and mail/email to

    Lori Lovett
    Project Leader
    Indiana Immunization Coalition
    26 Somerset Circle
    Brownsburg, IN 46112

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