BLS / ACLS / PALS PROVIDER COURSE
BLS, ACLS and/or PALS are mandatory requirements of the University of South Florida College of Medicine
residency programs and the Graduate Medical Education Committee (GMEC). All residents and fellows,
regardless of specialty, must have a current provider card throughout their residency/fellowship. Please note
that BLS is a requirement of the American Heart Association and mandatory in order to attend an ACLS or
PALS course.
BLS is required for all specialties
ACLS is required for all specialties, except Pediatrics* and Neonatology.
PALS is required for Emergency Medicine*, Pediatrics and Family Medicine
 Emergency Medicine, Family Medicine and Internal Medicine/Pediatrics are required to have both ACLS
& PALS certifications.
 Emergency Medicine, Internal Medicine/Pediatrics, Neonatology, OB/GYN, Pediatrics are required to
have NALS certification in addition to the above, you will receive info on this from our office closer to
the date.
 Emergency Medicine and Surgery are required to have ATLS certification. (TGH Trauma Center will
contact you concerning course location and textbooks)
 Neonatology is required to have NALS & BLS – Information concerning NALS will automatically be sent
in May to all who are required to take the course.
If you are currently certified – you MUST provide a copy of your card with the return of this form. Please note that if
your certification expires July 2012 through December 2012 you will need to be recertified prior to beginning our
programs. Certifications expiring in January or February 2013 will be automatically enrolled in a March 2013
renewal course and attendance will be mandatory. Failure to maintain provider status while in a USF program may
result in the loss of a vacation day to complete the course and the cost of the course being your responsibility.
Please complete the following:
_____
I am currently certified and am attaching a copy of my provider card (both BLS AND ACLS or
PALS) with this application. If you do not include a copy of your current provider status you WILL be enrolled in
the appropriate course and expected to attend on the scheduled date.
_____
I am NOT BLS certified – please enroll me in the Sunday, June 17, 2012 course. (7:30am –
10:30am at TGH)
_____
I am NOT BLS certified – please enroll me in the Sunday, June 24, 2012 course. (7:30am –
10:30am at TGH)
Please indicate below where you will be receiving e-mail effective through May 2012.
Your pretest will be sent to you via email the last week in May 2012.
_____
I am NOT ACLS certified – please enroll me in the Friday, June 22, 2012 course. (7:30am –
5:00pm at TGH) Please indicate below where you will be receiving e-mail effective through May 2012. Course
books & CD’s are on a loan basis and must be returned following the course. You will be held responsible for
the return of the text or will be charged $25.00 for its replacement. The Pre-test for ACLS is on CD – books will
be available for pickup from the TGH or USF GME offices, beginning 6/1/12. Please note: You MUST
complete a pretest with a score of 80% or better PRIOR to the course or you will not be allowed to take
the course.
_____
I am NOT PALS certified – please enroll me in the Wednesday, June 20, 2012 course. (7:30am
– 5:00pm at TGH) Please indicate below where you will be receiving e-mail effective through May 2012. Course
books & CD’s are on a loan basis and must be returned following the course. You will be responsible for the
return of the text or will be charged $40.00 for its replacement. The Pre-test for PALS is on CD – books will be
available for pickup from the TGH or USF GME offices, All Children’s Pediatric Residency Office or Morton Plant
Mease Family Medicine Office beginning 6/1/12. Please note: You MUST complete a pretest with a score of
80% or better PRIOR to the course or you will not be allowed to take the course.
NAME (Please PRINT)
Email address that will be effective through May 2012