STATE OF FLORIDA
Cardiopulmonary Resuscitation (CPR) or Advanced Cardiac Life Support (ACLS) Course Equivalency Form
Provide the following information:
A. Name of Entity Offering Course: ________________________________________________
B. Address of Entity: ____________________________________________________________
City: ______________________________ State: _______ Zip Code: __________________
Telephone: _____________________ FAX: _________________________
E-Mail Address: _____________________________________________________________
Contact Person: _____________________________________________________________
Contact Person’s Relationship to Entity: __________________________________________
C. Course title: _________________________________________________________________
(Note – A separate form must be submitted for each course title)
D. Attach a copy of the following documents:
1. Letter of approval for the above-named course from the Continuing Education Coordinating Board for Emergency Medical Services
2. Sample course completion certificate or card provided to student
Submit this completed form with both attachments to:
EMS Training Coordinator
Bureau of Emergency Medical Services
4052 Bald Cypress Way, BIN A-22
Tallahassee, Florida 32399-1722
Phone: (850) 245-4440
Fax: (850) 245-4378
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