You are on page 1of 2

Complete the form on the reverse side and mail with the appropriate payment to: Catholic Health

System Staff Development Office AppleTree Business Park 2875 Union Road, Suite 8A Cheektowaga, NY 14227 Make checks payable to Catholic Health System

To register:

presents

ACLS Provider Program


CME Accreditation
This program has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for CME (ACCME) through joint sponsorship with the University at Buffalo School of Medicine and Biomedical Sciences and St. Joseph Hospital. The University at Buffalo is accredited by the ACCME to sponsor CME for physicians. The UB School of Medicine & Biomedical Sciences designates this live activity for a maximum of 12.00 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Cardiac Life Support


Provider Course 2012

ACLS Recertification Program


CME Accreditation
This program has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for CME (ACCME) through joint sponsorship with the University at Buffalo School of Medicine and Biomedical Sciences and St. Joseph Hospital.
The University at Buffalo is accredited by the ACCME to sponsor CME for physicians. The UB School of Medicine & Biomedical Sciences designates this live activity for a maximum of 8.00 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their particitation in the activity.
Revised 11/2011

Catholic Health System Staff Development Office AppleTree Business Park 2875 Union Road, Suite 8A Cheektowaga, NY 14227

None of the instructors has financial relationships with any company whose drugs or devices will be discussed at this program.

Purpose:
This program is designed to meet the American Heart Association guidelines for training ACLS. This course is not meant to license, certify, or credential providers.

Recertification Program: $75 8 a.m. to 4 p.m. January 5, February 1, March 22, April 6, May 3, June 20, July 13, August 22, September 28, October 9, November 9 and December 7. Initial Provider Program: $75, Length-1.5 days Day 1 - 8 a.m. to 4 p.m. Day 2 - 8 a.m. to 11 a.m. Slated for February 2 & 3, April 19 & 20, June 21 & 22, August 23 & 24, October 18 & 19, and December 18 & 19. Fees for both courses do not include a textbook. Due to limited class size, please select two class dates at least two months in advance. To qualify for a recertification class, a copy of your most recent card must be attached. You will not be registered without this proof. Tuition for Catholic Health System associates and residents is $30 per course; FEE IS NON-REFUNDABLE. All associates must wear their name tag in class. Associate number must be included on form to be eligible for special rate. Course fees do not include the ACLS textbook. A textbook is required to be brought to class. If you need to purchase one, it is available for an additional $45. The Handbook of 2010 Guidelines contains a brief overview for an additional $35. Payment must accompany the registration form. No refunds are issued for cancellations. Rescheduling of a class will incur an additional enrollment fee. All returned checks for insufficient funds are subject to a $30 fee. Registration for CHS associates WILL NOT be accepted without a managers signature. Pre-registration is required. Classes fill up quickly. No phone registrations will be taken. Complete the attached form and send the required fee to secure a position in the class.

Learning Objectives:
l

Participant Requirements:

l

l Registrants are encouraged to have completed a

Tuition & General Information:


Classes are held at: AppleTree Business Park 2875 Union Road, Suite 8A Cheektowaga, NY, 14227

Registration Form

If you require specific aids or services during the class, please contact the course instructor at 706-2541 prior to course.

The Guidelines for 2010 should be reviewed BEFORE class.

BLS provider course within the past two years. A background in rhythm recognition is required. This course is not designed as a complete course in arrhythmia recognition. l Arrhythmia Class and ACLS Prep Course are available. Please call Staff Development for information at 706-2541.

ACLS Provider Course 2012

To review objectives, organize, and prioritize the skill and didactic information needed to handle a cardiac arrest, events that may lead to, and/or follow a cardiac arrest. l To evaluate and manage the first 10 minutes of a witnessed, adult VF cardiac arrest. l To demonstrate the critical actions designated by the American Heart Association in care for the tachycardia, bradycardia, pulseless patients, and those with ROSC.

Please complete and return with full tuition (Incomplete forms will be sent back) Is this a renewal? q Yes * qNo Date of Expiration: Make checks payable to: Catholic Health System * Attach a copy of card Name: Associate #: Address: City: State: Zip: Professional Status: Place of Employment: Telephone: Work ( ) Home ( ) Payment: q Catholic Health System Employee - $30 (Non Refundable) qCourse Text Book - $45 q Recertification Program - $75 - 1 Day Course q Handbook of 2010 Guidelines - $35 q Initial provider Course - $75 - 2 Day Course Total Amount Enclosed: $ CHS Manager Signature of Approval 2 Program Dates Requested: 1) 2)

Advanced Cardiac Life Support Provider Course