| Program Title |
State a brief and descriptive title |
| Intended Audience |
Nurses, specific levels of EMS or all levels of
EMT, social workers, nursing home administrators, etc. It can
also include people who do not need CEUs/CEHs. |
| Sponsor |
IHCC and the organization sponsoring (coordinating
or paying for) the event |
| Additional Co-Sponsor |
Any other organization that may be helping with
coordination or funding |
| Program Purpose |
Provide a general description and purpose of the
program. Examples: 1. To introduce and instruct individuals in
the process of developing an essential lifestyle plan for
persons with disabilities. 2. To provide participants with an
update on arterial blood gases and clinical signs and symptoms
exhibited during acidosis and alkalosis. |
| Faculty Name, Certifications & Title |
We must have a current CV or resume on file for
all presenters per regulations |
| Program Objectives
This essentially tells us the content of the program. The
licensing boards need to see that the objectives meet their
continuing ed criteria. If there are not enough objectives
listed, we may also need an outline of the course. |
Provide at least three specific, measurable
objectives
Example #1 Upon completion, the participant should be able
to:
- List at least 10 examples of drug-drug interactions.
- Identify potential drug-drug interactions after reviewing
a case study.
- Provide patients with concise drug information on
drug-drug interactions.
Example #2 Upon completion, the participant should be able
to:
- Discuss the Alzheimer's Disease process.
- Identify factors for creating a proper environment for
Alzheimer's victims.
- List 10 guidelines for the care and benefit of Alzheimer's
victims and caregivers.
Please avoid using the words "understand" or
"learn" because they are not easily measured. |
| For which disciplines are hours being
requested? |
Identify the disciplines with the hours requested
from the following list:
| X |
CEUs approved by the Iowa Board of
Nursing, Provider #12. |
| X |
CEHs approved for 100% attendance for all
levels of EMS by Provider #1500. |
| X |
hours of continuing social work education
approved by the Iowa Board of Social Work Examiners,
Provider #56. |
| X |
contact hours or continuing education
hours approved by Iowa State Board of Examiners for
Nursing Home Administrators. |
| X |
contact hours approved by the Iowa
Department of Health for Department Heads in Long Term
Care. |
| X |
hours approved by the Iowa Department of
Health for Residential Care Administrators. |
| X |
hours of funeral director continuing
education approved by Iowa Board of Mortuary Science
Examiners, Provider #412. |
|
| Start Date and End Date |
The date(s) the program will start and end |
| Location |
List the specific location, including room
numbers, if available. This is especially important if the
program is open to people outside of your organization |
| Sign-in Time |
Time that participants can begin signing in |
| Program Time |
Start and end time of the entire program |
| Cost to people within... |
State the cost to people within your organization
and to people outside of your organization. List all that is
included in the cost (i.e., materials, other fees). Also list
that which is not included, such as lunch or extra materials
that may be available for purchase. |
| Register by |
Date by which participants must register in order
to enroll in the program |
| Registration Procedure |
Describe how participants should register for this
program. This is particularly important for offerings open to
the public or other health care providers. Include a contact
person, phone number, address, email address, etc. |
| Cancellation Procedure |
Describe the procedure for cancellation if the
program could possibly be cancelled. |
| Contact Person |
List contact person, organization, etc. if this is
not already in the registration procedure. |
| Date of Request |
Date submitted to RHEP |
| Is the program open to health care
professionals outside of your organization? |
RHEP has a website on which all open programs can
be listed. Let us know if you want to make your training open to
others in the health care community through the RHEP website. |
