BLS Forms :: IHS Training Center :: UnityPoint Health - Des Moines | Paperwork

UnityPoint Clinic - Express

180 Jordan Creek Parkway, Suite 120
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Altoona

2720 8th St. SW
Altoona, Iowa 50009

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

2103 Ingersoll Ave., Ste. 2
Des Moines, Iowa 50312

Closed Patients
Waiting Now

Urgent Care - Ankeny

3625 N. Ankeny Blvd.
Suite E
Ankeny, Iowa 50023

Closed Patients
Waiting Now

Urgent Care - Lakeview

6000 University Avenue
Suite 101
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

Urgent Care - Merle Hay

4020 Merle Hay Road
Suite 100
Des Moines, Iowa 50310

Closed Patients
Waiting Now

Urgent Care - Southglen

6520 SE 14th St.
Des Moines, Iowa 50320

Closed Patients
Waiting Now

Urgent Care - Urbandale

2901 86th Street
Urbandale, Iowa 50322

Closed Patients
Waiting Now
UnityPoint Health - Des Moines

BLS Forms

Course Paperwork

All Courses

  • 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.
  • Roster Form- submit within 2 weeks following the course 
  • Adult and Infant skills sheets
  • Appropriate Skills Checklist(s)- submit within 2 weeks following the course (see below)
  • Card Order Form (pdf) or Card Order Form (Word) - use this form to order cards    
  • Equipment Reservation Form- use this form to reserve equipment
  • Instructor Credit Form - use this form when teaching for another Training Center

Heartsaver CPR AED, Heartsaver Pediatric First Aid CPR AED Courses, Bloodborne Pathogens

All Heartsaver courses use the same CPR AED & First Aid skills sheets for both Instructor-Led & Online course skills sessions. 

  • Heartsaver CPR AED Skills Testing Checklists (Adult, Child, Infant)
  • Heartsaver First Aid Skills Testing Checklist
  • Exam answer sheet - if exam was administered

Healthcare Provider Instructor-Led Course or HeartCode BLS

  • Healthcare Provider Skills Testing: Adult and Infant BLS 
  • Written exam Answer sheet

HeartCode BLS Reference for students

  • Healthcare Provider Skills Testing: Adult and Infant BLS 
  • Heartcode online completion certificate

Note: When utilizing online courses for participants, please submit the online course certificate as proof of completion of the written exam.