Name:
Name:CPR / ACLS / PALS / NRPYou must have the American Heart Association’s (AHA), Cardiopulmonary Resuscitation (CPR) and Advanced Cardiac Life Support (ACLS) certification, prior to starting your residency. If you are in Pediatrics, in lieu of ACLS, you must have Pediatric Advanced Life Support (PALS) certification. Pediatric and OB/GYN residents also need to be certified in the Neonatal Resuscitation Program (NRP). If you have already completed these classes and have valid cards, please indicate in the space provided below and FAX or email a copy of your card to the Medical Education Office. If you are not currently certified, please indicate in the space provided which course(s) you will be attending during Orientation.CPROnline Class FORMCHECKBOX I am CPR Certified. FORMCHECKBOX I am sending a copy of my BLS card. FORMCHECKBOX I will complete the online CPR course.ACLSPart 1Wednesday, June 14, 2017 FORMCHECKBOX I am ACLS Certified. 11:00 a.m. to 5:00 p.m. FORMCHECKBOX I am sending a copy of my ACLS card. FORMCHECKBOX I will attend this ACLS course.ACLSPart 2Thursday, June 15, 2017 FORMCHECKBOX I will attend this ACLS course.8:00 a.m. to 5:00 p.m.PALSPart 1 FORMCHECKBOX I am PALS certified. Wednesday, June 21, 2017 FORMCHECKBOX I am sending a copy of my PALS card.8:00 a.m. to 5:00 p.m. FORMCHECKBOX I will attend this PALS course.Part 2 FORMCHECKBOX I will attend this PALS course.Thursday, June 22, 20178:00 a.m. to 5:00 p.m. NRPFriday, June 23, 2017 FORMCHECKBOX I am NRP certified. 8:00 a.m. to 1:00 p.m. FORMCHECKBOX I am sending a copy of my NRP card. FORMCHECKBOX I will attend this NRP courseI am currently ACLS/PALS/NRP certified, but it expires prior to December 31, 2017. I have sent a copy of my cards. I have registered for ACLS/PALS/NRPrenewal courses on at (dates) (location) ................
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