Moderate Sedation Re-Certification

Moderate Sedation Re-Certification
CEs awarded for your nursing license is acceptable.

Re-certification fee: $225.00
Name:
Sedation Certification Expiration:
Mailing Address:
This is where your certificate will be mailed USPS.
City:
State:
Zip:
Phone (Home):
Phone (Work):
Email:
example@example.com
Nursing License #:
Advanced Nurse License #:
PA License #
State Licensed:
License Expiration Date:

MonthDayYear
Date
Current ACLS or PALS required for recertification
ACLS Expiration Date:

MonthDayYear
Date
PALS: Expiration Date:

MonthDayYear
Date
Place of Employment:
Where do you give sedation? i.e. ED, Endoscopy, Peds etc:

List your CE credits: (30 CEs required credits for re-certification)

Total number of CE credits
Include the $225.00 Re-Certification fee with documentation of 30 CE Credits. If your certification is more than 30 days expired, please include the $50 expired certification fee.
PLEASE NOTE YOUR CREDIT CARD STATEMENT WILL READ "HEALTHY VISIONS"

Re-Certification is every two years from original certification date.

Healthy Visions 351 Market Street Clinton, TN 37716 865-269-4616 www.sedationcertification.com
Please allow 14-21 days for your recertification to be processed.

My Products

Moderate Sedation Re-Certification Fee

$225.00

Late Fee Moderate Sedation Re-Certification (if expired more than 30 days)

$50.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country