REQUEST FOR USING BRN NUMBER 00901 - Stanford Health …



In order to meet California BRN requirements the following information is needed:

Title of Course: _______________________________________________________________________________

Date of Course: ___________________ Location: _________________________

Start Time: End Time:

Number of BRN CEs Requested: ________________ APPROVED__________

Course Coordinator:

Mail Code or Email:

Other contact information:

Please attach the following information:

( Behavioral Objectives - 1 per CE contact hour

( Detailed course outline/program agenda indicating time/length of each lecture

( Curriculum Vitae, Resume, or Bio for each speaker

( Course evaluation template: (Circle one) Written or Online with detailed summary

( Each speaker’s PowerPoint presentation and/or handouts (copy or electronic)

( Content Tracking Form, one per course – Magnet documentation

( Completed BRN CE Sign-in roster template (NEW!)

Fees:

$10.00 fee per individual participant for programs with 5.75 CE contact hours or less

$20.00 fee per individual participant for programs with 6 CE contact hours or more

• Method of payment: Checks only made payable to Stanford Health Care (SHC)

• Per SHC’s Corporate Cash Receipts Collection Policy, deposits should be processed as soon as possible, preferably on the same day they are received. Please ensure the CEPD receives checks within 3 business days.

Approval: __________________________________________ _______________

BRN Content Expert’s Signature and Title Date

GENERAL INFORMATION

Approval for CE contact hours requires review by the CEPD. Please submit the following information PRIOR to advertising or designating a course as approved for BRN credit:

• Title of Program

• Date/time and location of course

• Behavioral Objectives written in measurable outcomes 1 per CE Contact Hour

• Detailed course outline/program agenda indicating time/length of each lecture

• Curriculum Vitae, Resume or Bio for each speaker

• Number of CE contact hours requested

o 1 hour theory = 1 CE contact hour, 3 hours clinical practice = 1 CE contact hour

o BRN guidelines specifically state CEs cannot be given for courses relating to orientation, CPR, BLS, Basic ECG, Basic IV, self-improvement, financial gain, liberal arts unrelated to patient care, and courses designed for lay people

o Program must be at least 1 hour in length

• Course evaluation template either written or online with detailed summary evaluation

Submit to CEPD via Fax 650-725-9937 or email CECenter@

You will be notified via email as soon as the program has been approved.

In compliance with BRN regulations, any advertisement of the program must contain:

• The policy for refund of fees in cases of canceled courses or nonattendance

• A clear, concise description of the course content and objectives

• The statement “Stanford Health Care is an approved provider by the California Board of Registered Nursing, Provider Number CEP12165 for _____ contact hours”

Please let us approve the brochure before it is printed

UPON COMPLETION OF THE PROGRAM

Submit the following documents to:

ATTN: BRN Approval @SHC (CEPD), 300 Pasteur Drive, MC 5534, Stanford, CA 94305

• BRN CE Sign-in roster (NEW!)

- If names are not legible or if RN number is missing, the CE certificate will not be issued!

• Payment for CE certificates

• Each participant’s course evaluation form or online detailed summary evaluation

• Content Tracking Form for each lecture/speaker (Magnet requirement)

• PowerPoint copies and/or handouts used for this course

CE certificates will be mailed to the course coordinator for distribution within 90 days.

Please email all questions to: CECenter@

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