ACLS Reimbursement Request Form

Please read the following instructions carefully.

Required Documentation

  1. Copy of ACLS certification card
    AND
  2. Proof of payment (one of the following):
    • Original credit card statement.
    • Original receipt: Must show date of training, place of training, and amount paid.
    • Copy of both sides of your cancelled check.

Reimbursement Eligibility

Residents and fellows in these programs are eligible for ACLS reimbursement by 12/31/22:

  • Anesthesiology
  • Cardiovascular Disease
  • Clinical Neurophysiology
  • Emergency Medicine
  • Family Medicine Sports Medicine
  • Family Medicine/Family Medicine Rural
  • Gynecologic Oncology
  • Internal Medicine
  • Internal Medicine CHS
  • Internal Medicine/Pediatrics
  • Internal Medicine/Preventive Medicine
  • Interventional Cardiology
  • Neurological Surgery
  • Neurology
  • OB GYN-Catholic Health System
  • Oral & Maxillofacial Surgery
  • Orthopaedic Surgery
  • Osteopathic Family Medicine
  • Otolaryngology
  • Pediatric Anesthesiology
  • Pediatric Emergency Medicine
  • Psychiatry
  • Surgery
  • Vascular Surgery 
  • Vascular Surgery Integrated