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UnityPoint Clinic - Express (Ankeny)

1055 Southwest Oralabor Road
Ankeny, IA 50023

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UnityPoint Clinic - Express (Jordan Creek)

180 Jordan Creek Pkwy
West Des Moines, IA 50266

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UnityPoint Clinic - Express (Waukee)

950 E Hickman Rd
Waukee, IA 50263

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UnityPoint Clinic Family Medicine | Urgent Care - Lakeview

6000 University Avenue
West Des Moines, IA 50266

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UnityPoint Clinic Urgent Care - Altoona

2720 8th Street Southwest
Altoona, IA 50009

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UnityPoint Clinic Urgent Care - Ankeny Medical Park

3625 North Ankeny Boulevard
Ankeny, IA 50023

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UnityPoint Clinic Urgent Care - Ingersoll

2103 Ingersoll Avenue
Des Moines, IA 50312

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UnityPoint Clinic Urgent Care - Merle Hay

4020 Merle Hay Road
Des Moines, IA 50310

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UnityPoint Clinic Urgent Care - Southglen

6520 Southeast 14th Street
Des Moines, IA 50320

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UnityPoint Clinic Urgent Care - Urbandale

5200 NW 100th Street
Urbandale, IA 50322

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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.