Electrocardiography (EKG) Program Approval Checklist
Name of School/Training Facility:____________________________________
|
| Enclosed is documentation and or proof of the following program approval requirements. | Yes | No |
| 1. Properly completed application | | |
| 2. Application and yearly fees | | |
3. Instructors:
Resume
Copy of Licensure
Health Care Professional | | |
| 4. School/training facility brochure | | |
| 5. Course breakdown | | |
| 6. Program outline | | |
| 7. Specific Lesson Plans | | |
| 8. Pictures of school/training facility | | |
| 9. List of equipment | | |
| 10. Entrance Exam (optional) | | |
| 11. Certificate of Student Malpractice Insurance | | |
| 12. Grading, attendance and tardiness form(s) | | |
| 13. Copy of Certificate of Completion | | |
14A. Letter about health care requirements, or form
HBV immunization form and declination form | | |
| 15A. STUDENT HANDBOOK CONTAINING: | | |
| 15B. Guidelines for program admission | | |
| 15C. Rules on absences and tardiness | | |
| 15D. Dress Code | | |
| 15E. Program Objectives | | |
| 15F. Class Syllabus | | |
| 15G. Grading policy and minimum passing requirements | | |
| 15H. Withdrawal and refund policy | | |
| NECESSARY COMPETENCIES FOR EKG APPROVAL |
| 1. Program is at least 40 hours in length | | |
| 2. The student does at least 5 EKG's and 1 additional to be mounted and labeled properly; signed and dated by the instructor. To be submitted with examination | | |
| 3. A list of references and textbooks used | | |
4. Anatomy and Physiology
a. The Heart, in detail
b. The Circulatory System, in detail
c. The Conduction System, in detail | | |
5. EKG, heart, circulation, and conduction systems:
Terminology and abbreviations | | |
| 6A. Parts of the EKG machine | | |
| 6B. EKG paper calculations | | |
| 6C. Standardization | | |
| 6D. Marking Codes | | |
| 6E. Patient Preparation | | |
| 6F. Patient Dignity | | |
| 6G. Proper Lead Placement | | |
| 6H. Leads | | |
| 6I. EKG waves; relation to heart action | | |
| 6J. Common Artifacts | | |
| 6K. Cardiac Arrhythmias | | |
| 6L. Cardiac Blocks | | |
| 7. Lab Practice: what is covered in each lab practice. Number of hours spent in each lab session | | |
| 8. CPR Certification (There must be a CPR Certificate awarded) | | |
Comments:
Approved:__________________Date:________
| | |