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

UnityPoint Clinic Urgent Care - Altoona

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UnityPoint Clinic Urgent Care - Ingersoll

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Urgent Care - Ankeny

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Urgent Care - Lakeview

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Urgent Care - Merle Hay

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Urgent Care - Southglen

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Urgent Care - Urbandale

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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
  • 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 Core Cases        
    • 2016-PALS Case Scenario Testing Checklists - 2 cases per student (1 Respiratory or shock, 1 cardiac)
  • Heartcode completion certificate

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