Notification of Program Completion Form

Notification of Program Completion Form - PHRM Training Program
Complete the following form to declare that you have completed the requirements of your training program as outlined in Regulation F.

Note: Please retain all WBAs and meeting documentation from your PHRM Training Portal that you wish to keep, as once this form is submitted you will no longer have access.
Your Name*

First NameLast Name
Email*
example@example.com
ACEM ID*
PHRM Assessments*

A minimum six-month 1.0FTE placementTraining Supervisor Reports (TSRs) every 3 calendar months4 Multi-source Feedback (MSFs)2 Mission Assessments (MAs)4 Direct Observation of Technical Skills (DOTS): including mandatory Transport Monitor/Defibrillator and Transport Ventilator3 Direct Observation of Procedural Skills (DOPS): including mandatory Prehospital or Retrieval Emergency Anaesthesia3 Case Based Discussions (CbDs)Task Logbook submitted via the DipPHRM PortalWritten ExaminationPractical Examination
Final Declaration*

I confirm that I have completed all requirements, and all my assessment have been entered in the PHRM Portal.
Should be Empty:

Notification of Program Completion Form - PHRM Training Program