EMR Recertification Course Registration

Student Information

Full Name*

First Last

Email Address*

Please use your personal email address rather than a work or school account. Course instructions will be emailed to this address, and it will also become your username for logging into the online course.

Enter Email Confirm Email

Alternate Email Address

If you sometimes use another email address, like a work or school account, please enter it here.

Enter Email Confirm Email

Phone Number*

Just in case we can't reach you by email.

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Certification Info

EMR 16 Hour NCCP Course

Select type of recertification*

Expiration date of your NREMT certification*

You must complete recertification training before your expiration date.

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Enter your national registry number

Log in to your NREMT account here to find your registry number. It is a letter followed by seven numbers (for example: A12345678). If you cannot find this number now, you will just need to send it to us before completing the course.

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Enter your 12 digit NREMT EMS ID

This is the new 12 digit number assigned to all NREMT-certified personnel also found within your NREMT account. If you cannot find this number now, you will just need to send it to us before completing the course.

Select renewal State*

Please ensure your state accepts a CAPCE accredited 16 hour EMR recertification course. Contact us if you have questions.

Expiration date of your state EMR certification/license*

Enter your State EMR certification/license number

If you do not have this number now, you just need to send it to us before finishing the course.

Are you a licensed Peace Officer?*

This course qualifies for POST credits.

POST license number

This field only applies if you are a licensed Peace Officer that would like to receive POST education credits for this course.

BLS Certification

The Minnesota EMS Board highly recommends EMRs maintain BLS certification (CPR for Healthcare Providers), and it's also required by most employers. We provide a BLS course for those who need it.

BLS Classroom Session*

A classroom session is required to practice and test out on your skills at our EDINA facility (7405 Bush Lake Road, 55439).

Anything else you'd like us to know?

Payment

Promo Code

Northwestern Health Verification*

I verify that I am currently a student or faculty/staff member of Northwestern Health Sciences University.

Total

$0.00

Payment Method*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Invoice to a Sponsoring Organization

Did your organization give you a code to enter when registering?*

Organization ID Code*

Enter the code below

Name of Organization*

Contact Person at Organization*

Phone of Contact Person*

Email of Contact Person*

Mailing Address of Organization*

Instruction for Submitting Invoice

Enter any specific instructions we should know about submitting an invoice to this organization (for example: what to include in the memo, etc).

Terms & Conditions

Invoice Terms and Conditions*

I understand and agree that the organization above has authorized payment for my course fees.

Verification of EMR Certification/License*

I verify that my EMR certification/license is valid and has NOT expired, and I have sufficient time to complete the recertification training before my certification/license will expire. I also understand that this course is for EMR-level providers only, and is not for EMTs.

Lapsed EMR Certification/License*

I verify understanding that I must complete the entire 16 hour recertification training by October 31 (within one year of expiration) to be eligible to regain EMR certification.

Terms and Conditions*

I understand and agree to the TERMS AND CONDITIONS

State Acceptance*

I understand that it is my responsibility to verify that my state (if not Minnesota) will accept this refresher course.

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Signature of Student

By typing my first and last name below, I verify understanding and agree to the terms and conditions. I also verify that the person completing this form is the student enrolling in the course.