PALS Forms :: IHS Training Center :: UnityPoint Health - Des Moines | Check out the course paperwork for renewal and provider

UnityPoint Clinic Urgent Care - Altoona

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

Closed Patients
Waiting Now

Urgent Care - Ankeny

Closed Patients
Waiting Now

Urgent Care - Lakeview

Closed Patients
Waiting Now

Urgent Care - Merle Hay

Closed Patients
Waiting Now

Urgent Care - Southglen

Closed Patients
Waiting Now

Urgent Care - Urbandale

Closed Patients
Waiting Now
UnityPoint Health - Des Moines

PALS Forms

Course Paperwork (Provider and Renewal)

Submit prior to the course

*If you modify the agenda set forth in the instructor manual, you must also submit this to the CTC for approval prior to the course.

 Submit all forms within 2 weeks following the course.  

  • PALS Roster - one per course    
  • Participant Registration - one per student
  • Course Evaluation - summarize and tally on one blank form
    • Classroom course evaluation
  • Card Order Form(pdf) or Card Order Form(Word) - one per course
  • BLS Skills Testing:  Child & Infant- one per student
  • PALS Core Cases
    • PALS Case Scenario Testing Checklists - (1 Cardiac case & 1 Respiratory OR Shock case)
  •  Written Test Answer Sheet- one per student

HeartCode PALS 

  • PALS Roster - one per course 
  • Participant Registration - one per student
  • Course Evaluation - summarize and tally on one blank form 
    •  Online course evaluation
  • Card Order Form (pdf) or Card Order Form (Word) - one per course
  • BLS Skills Testing: Child & Infant- one per student
  • 2016  Airway Management- one per student
  • 2016 Vascular Access-one per student
  • 2016 Rhythm Disturbances -one per student
  • PALS Core Cases        
    • 2016-PALS Case Scenario Testing Checklists - 2 cases per student (1 Respiratory or shock, 1 cardiac)

PEARS Course Paperwork

Submit prior to the course

  • Course Planning Form - submit 3 weeks prior to course if the CTC can share course information with any interested community members. 

*If you modify the agenda set forth in the instructor manual, you must also submit this to the CTC for approval prior to the course.

Submit within 2 weeks following the course