• Continuing Education Offerings Application

    Updated 8-19-22
  • Continuing Education Offerings Application Process

    Use this form for the following types of continuing education:

    • Emergency Medical Services Agency (EMT/EMT-P)
    • Physical Therapy Board of California
    • Speech-Language Pathology, Audiology and Hearing Aid Dispensers Board

    Do not use this form for:

    • California BRN CEs: An alternate process was adopted in Aug 2022. Contact justin.dauterman@sfdph.org  for more information.
    • California Department of Public Health (CDPH) CEs for Certified Nursing Assistants. ZSFG DET is currently not an approved provider for these CEs.

    Documents required with this online application include:

    1. Announcement/flyer  publicizing the course must contain:
      • course title and description;
      • date, time, and location;
      • target audience;
      • registration and contact information;
      • specific approval statements required by the regulating Board (identified in Course Details below);
      • and organization's cancellation policy (identified in Course Details section below).
    2. Teaching/presentation materials such as:
      • agenda;
      • syllabus/outline;
      • handouts and tests template (if applicable); and
      • evaluation template.
    3. Instructor(s)' Curriculum Vitae/resume
    4. Presenter(s)' Disclosure of Financial Interest  (see Template Resources below)
    5. If seeking approval from Physical Therapy Board of California:
      • Download the application and requirement guideline for Physical Therapy Board of California and Speech-Language Pathology, Audiology and Hearing Aids Dispensers Board  and assure that you meet all the requirements for approval.  
      • Attach the additional application form found within this document and all other requirements with this online application.  

    Late and/or incomplete applications will not be approved.  Course approval is required prior to advertising a course.  For Board of Registered Nursing approval, adverstising while under the review process requires the following statement on you announcement/flyer "Continuing education credit approval pending." 

     

    Template Resources may be downloaded, utilized and modified as appropriate without removing the required elements (update coming soon):

    • Continuing Education Planner and Presenter Disclosure Form:   this is included in this online application form.  However, utilize this downloadable form if you need a vendor to complete this requirement.  Attach the vendor-completed disclosure form with this online application
    • Announcement/flyer
    • Evaluation
    • Self-Study & Web-based Course Outline is required for Self-Study and Web-based course types
    • Attendance: if the course is approved, this attendance form is required and should be submitted within 2 weeks after course completion

    For any questions or concerns, please send an email to the DET Manager, Justin Dauterman, MSN, RN, NPD-BC (justin.dauterman@sfdph.org 628-206-4171)

  • Instructor/Facilitator's Information

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  • Course Information

  • Course Details

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  • Reminder: An announcement/flyer requires the following elements:

    • Course title, description, and learning objectives
    • Date, time, and location of course
    • Target Audience
    • Registration/contact information
    • Additional elements required for Physical Therapy Board of California and Speech-Language Pathology, Audiology and Hearing Aid Dispensers Board approval
      • Program schedule
      • Speaker names, titles, and qualifications
      • Type of instructional method(s) (lecture only, lecture w/demonstration, lecture w/hands-on/technique lab)
      • Student-to-faculty ratio (only necessary if course contains hands-on/technique lab
    • An approval statement that includes the name of approval agency/continuing education provider, its identification number, and the number of contact hours it is approved for:

    This course is approved for __ CE contact hour(s) by San Francisco General Hospital Nursing Services, an approved continuing education provider by the {Physical Therapy Board of California} OR {Speech-Language Pathology, Audiology and Hearing Aid Dispensers Board (PDP# 204)}.

    Cancellation policy:

    Cancellation Policy: An attendee-initiated cancellation at 10-days or more before the class date is entitled for a full refund or a
    voucher applicable towards a future class; a cancellation less
    than 10 days before the class date is not entitled for a refund or
    voucher. A department-initiated cancellation entitles the attendee
    for a full refund or voucher towards a future class. These terms do
    not apply to free courses.

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  • Continuing Education Planner and Presenter Disclosure Form

    A downloadable version of this disclosure form is included in the Template Resources should you need a vendor to complete this requirement.

  • This continuing education disclosure form is to assist in identifying and resolving any potential conflicts of interest. A conflict of interest exist when an individual has a financial relationship with a commercial interest and has the chance to affect the educational content related to that commercial interest. The goal is to maintain balance, independence, objectivity, and scientific accuracy of all educational offerings. Disclosed financial relationships with a commercial interest is not the basis for continuing education offerings approval. However, if you are not able to disclose any financial relationships for any reason, your activity or course will not be approved to offer continuing education credits. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Excluded from these are providers of clinical service directly to patients: non-profit or government agencies; non-health care related companies, liability and health insurance providers; group medical practices; for-profit hospitals; rehabilitation centers and nursing homes; blood banks; and diagnostic laboratories. Included into what needs to be disclosed are ownership of commercial interests, membership on boards of directors, trustees or advisory committees of commercial interests, grants or research support from commercial interests (excluding government, non-profit, or independent foundations), affiliate of commercial interests (including stock holder but not mutual fund holdings, employee/consultant, and member of speakers bureau).

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