Regional & Training Center Faculty Forms :: Instructor Resources :: IH-DM Training Center :: Residency & Education Programs :: UnityPoint Health - Des Moines | Check out the forms for the Faculty training center

UnityPoint Clinic Urgent Care - Altoona

2720 8th St. SW
Altoona, Iowa 50009

00 Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

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

05 Patients
Waiting Now

Urgent Care - Ankeny

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

05 Patients
Waiting Now

Urgent Care - Lakeview

6000 University Avenue
Suite 101
West Des Moines, Iowa 50266

03 Patients
Waiting Now

Urgent Care - Merle Hay

4020 Merle Hay Road
Suite 100
Des Moines, Iowa 50310

03 Patients
Waiting Now

Urgent Care - Southglen

6520 SE 14th St.
Des Moines, Iowa 50320

01 Patients
Waiting Now

Urgent Care - Urbandale

2901 86th Street
Urbandale, Iowa 50322

00 Patients
Waiting Now
UnityPoint Health - Des Moines
Training Center Faculty Forms

Submit within 2 weeks following an instructor course:

New Instructors

  • Copy of current Provider card (in the appropriate discipline)

  • Course Roster  
  • Participant Form (BLS, Heartsaver Instructor) 

  • Participant Form (ACLS, PALS, PEARS Instructor) 

  • Instructor Candidate Application - on the AHA Instructor Network

  • Alignment Form 

  • Exam Release Form

  • Card Security Form 

  • Monitoring Form - on the AHA Instructor Network

  • Course Evaluation Summary

  • Card Order Form (pdf) or Card Order Form (Word) 

     

    Additional course forms for each discipline's provider skills and written exam answer sheet (if applicable) should also be submitted (i.e. ACLS Provider skills forms, PALS, HCP or Heartsaver).

    * An additional letter of recommendation is no longer required.  The verification of instructor potential can be found on the instructor Candidate application. 

     Note: instructors will have access approved on the AHA Instructor Network when all of the documentation has been received by the Training Center (including initial monitoring).

Renewing Instructors

  • Course Roster  

  • Instructor Renewal Checklist (Instructors only) - on the AHA Instructor Network

  • Training Center Faculty Renewal Checklist  (Training Center Faculty only)- on the AHA Instructor Network

  • Participant Form (BLS, Heartsaver Instructor)

  • Participant Form (ACLS, PALS, PEARS Instructor)

  • Monitoring Form - on the AHA Instructor Network

  • Course Evaluation Summary

  • Card Order Form (pdf)  or Card Order Form (Word) 

Additional course forms for each discipline's provider skills and written exam answer sheet (if applicable) should also be submitted (i.e. ACLS Provider skills forms, PALS, HCP or Heartsaver).


Additional Tools

AHA Course Matrix 

ECC Course Card Reference Guide (New-11/2016)

Meeting Monitoring Requirements for Instructor Renewal - Instructors may now be monitored during online skills sessions.  This can be for new or renewing instructors.  (See November 2016 Newsletter.)

Program Administration Manual - on the AHA Instructor Network 

/desmoines/filesimages/Education Center/Training Center/Forms/2019/Resource Sheet wg1.docx (CTC & AHA contacts, websites, etc.)

Instructor Course Completion Notice to Primary TC



Instructor Alignment

Instructors requesting alignment or transfer of instructor records to UnityPoint Health - Des Moines CTC will need to contact the CTC for further information.