Meriter Hospital Community Training Center
2015 – ACLS for Health Care Providers Registration Form
Complete and return this form with your payment to reserve your class enrollment.
Payments can be made via check or credit card – more details can be found on the next page.
Indicate which date you wish to attend.
Registrations received after the registration ends will not be considered.
The course will present the information standards and skills developed by the American Heart Association for Advanced Cardiac Life Support certification and recertification. The material will be presented through the use of lecture, interactive discussions and skills sessions. Participants will complete both written and performance examinations.
Upon completion of this course, participants will be able to direct a team of health care providers in a simulated cardiac arrest situation. In addition, participants will learn such skills as airway management, defibrillation/ cardioversion and use of an AED, application of therapeutic modalities based on recognition of dysrhythmias.
Recognition (2 day course)
May 28 & 29 Registration ends 04/7/15
July 29 & 30 Registration ends 07/07/15
October 01 & 02 Registration ends 09/10/15
December 03 & 04 Registration ends 12/12/15
Recertification (1 day course)
May 22 Registration ends 05/01/15
June 05 Registration ends 05/15/15
July 10 Registration ends 06/16/15
October 23 Registration ends 10/02/15
November 20 Registration ends 10/30/15
December 18 Registration ends 11/27/15
This class is offered through our partner, Center for Healthcare Excellence and Simulation. To view the class schedule and register, please visit www.CHESwi.org.
Physicians, nurses and paraprofessionals involved in critical care/emergency care situations.
• ECG interpretation skills required. Must be able to identify static and dynamic rhythms.
• All applicants should have a current Health Care Provider CPR card at registration. If you are not current in CPR, please arrange to do so as soon as possible, hopefully before your ACLS course.
• All renewal candidates need to submit a previous ACLS (Advanced Cardiac Life Support) card. This can be presented at registration.
• It is necessary that the renewal participant be thoroughly familiar with all ACLS concepts. The focus of the renewal portion of the course is designed toward an update of current ACLS protocols and skills and successful skills demonstration / validation.
Class materials will be mailed upon confirmation of payment to the address indicated on registration form above .
Statement of Accreditation
Meriter-UnityPoint Health is accredited by the Wisconsin Medical Society to provide continuing medical education for physicians.
Credit Designation Statement (for ACLS Recognition Course)
Meriter-UnityPoint Health designates this live activity for a maximum of 16 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Credit Designation Statement (for ACLS Renewal Course)
Meriter-UnityPoint Health designates this live activity for a maximum of 8 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The American Heart Association strongly promotes knowledge and proficiency in ACLS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association, and any fees charged for such a course do not represent income to the association.