San Francisco General Hospital Medical Center
Department of Education and Training
Continuing Education (CE)
The Department of Education and Training must approve the course content and Instructor’s qualifications to
grant CE approval. We will also need a copy of the class Flyer and/or Brochure Therefore, 2 weeks prior to
advertising the class please complete and submit the following:
 Course Information Form
 Instructor Resume or Curriculum Vitae
 Copy of class Flyer and/or Brochure
(date)
_______________
_______________
_______________
After approval, you may advertise your class. We will also make available to you supporting materials to
assist you in meeting the legal requirements dictated by Title 16, Division 14, Article 5. We recommend that
you familiarize yourself with these guidelines.
http://www.rn.ca.gov/applicants/cep-lic.shtml#audits
http://www.rn.ca.gov/pdfs/applicants/cepinstruct.pdf
http://www.rn.ca.gov/pdfs/applicants/ceptitle16.pdf
Upon completion of the course, please submit the following:




Completed Attendance Forms (signed by instructor/course co-coordinator)
Copy of any handouts, educational packets
Completed Student Course Evaluations
Copy of CE Certificate (signed and dated by instructor)
If all the required documents are not returned to DET after the course is complete we will not be able to
assign CE credits and instructors who are unable to follow the process completely may lose their ability to
offer classes with our BRN number in the future. Your success is very important to us and we are available at
any point during the process to assist you.
San Francisco General Hospital Medical Center
Course Information Form
Directions:
 For CE: Complete this form and submit to SFGHMC DET for CE approval at least two weeks prior to advertising class
 For non-CE: Complete this form and submit to SFGHMC DET with attendance records for database entry
1. Course Name: ____________________________________________________________________
2. Coordinator & Title: _____________________________________ Phone: ____________________
3. Course Instructors & Title (For CE, attach Instructor verification form/CV or note that form on file):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
4. Course Delivery Methods:  Lecture  Classroom  Skills workshop  Case study  Other- ________
5. Course Description: ________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
6. At least 3 measurable Course Objectives:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
7. Target Students: __________________________________________________________________
8. Class Date(s): ___________________
CE Hours: __________  None
Time: __________ Location: ________________________
Registration Fee: __________  None
9. Comments: ______________________________________________________________________________
________________________________________________________________________________________
Choose categories that apply:


Clinical Specialties
 Cardiology
 Critical Care
 Emergency
 General
 Geriatrics
 HIV/AIDS
 Home Care
 Mental Health/Substance
Abuse
 Oncology
 Perinatal
 Respiratory
 Skilled Nursing
 Trauma








Compliance
Computer Skills/IS
Leadership/Management
Nursing
Orientation
Regulatory
 BBP
 Safety Devices
 General
Rehabilitation
 PT
 OT
 ST
Risk-Quality Management
Other: _____________
___________________
___________________
Life Support
 BLS  ACLS  PALS
 Neonatal Resuscitation
For DET use only:
Course approved for ______ hours CE by: __________________________________________ Title: ______________
Course coordinator notified: (date) _________________
HPF (Rev. 03/16/06)
___________________________________________________________________
For Office Use Only
For RN Instructors:
1.
2.
Holds a current valid license to practice as a Registered Nurse. Is free from any disciplinary action by
the California Board of Registered Nursing.
Is knowledgeable, current and skillful in the subject matter of the course:
a.
Holds a Baccalaureate or higher degree from an accredited College or University and can validate
experience in the subject matter: or
b.
Has experience in teaching similar subject matter within two years preceding the course: or
c.
Has at least one year's experience within the last two years in the specialized area in which s/he is
teaching.
The Non-Nurse Instructor
1.
2.
3.
Is currently licensed or certified in his/her area of expertise, if appropriate: and
Shows evidence of specialized training, which may include but not be limited to, a certificate of training
or an advanced degree in a given subject area; and
Has at least one year's experience within the last two years in the practice of teaching of the specialized
area in which s/he teaches.
Sample Flyer
Required Fields in red:
1. CE Providers name on file with BRN
2. Clear Concise dourse description with measurable course objectives
3. The full statement Provider approved by the California Board of Registered Nursing, Provider Number
_______for _____contact hours”
4. The provider’s policy regarding refunds.
San Francisco General Hospital
CLASS NAME
Instructor Name, RN etc.
Sponsor Department if applicable
2/27/06
MONDAY
9:00-9:15 AM and 8:00-8:15PM
LOCATION: 4H10
Clear/concise course description and measurable course objectives
Contact Person / Phone #
Registration Info / Fees etc. if applicable (e.g. To register please submit Name,
License number, and phone number along with check made out to "SFGH
Foundation” (if appropriate) to: name and location or call (415)-206-XXXX
Provider approved by the California Board of Registered Nursing,
Provider Number 858 for
X
contact hours. Provider: San Francisco General
Hospital – Nursing.
Cancellation Policy: In the event of a student initiated cancellation 10-days or more before the starts of class the
student will receive a full refund or a voucher applicable towards a future course (less a $10 processing fee). If the
cancellation occurs less than 10 days prior to the start of class there will be no refund or voucher applied. In the event
of a DET initiated cancellation the student will receive a full refund or voucher toward a future class.
A $10 service fee will be charged for all returned checks
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