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FCCS Registration

Please direct inquiries to:
Beverly Fletcher, FCCS Course Coordinator
1211 21st Avenue South, MAB Ste. 526
Nashville, TN 37212
PH: 615-936-2454 FAX: 615-936-7059
Email: Beverly.S.Fletcher@vanderbilt.edu

NEXT AVAILABLE COURSE DATES:
May 21-22, 2016 (FILLED)

September 10-11, 2016 (FILLED)

Please indicate course date

Name

Address Line One (CANNOT SHIP TEXTBOOKS TO P.O. BOX)

Address Line Two (City/State/Zip)

Cell phone, including area code
Work phone, including area code

Email address

Employment/School: (facility/affiliation/organization)

Position

Area of Specialty

Are you a: (Please check one)

Physician Physician Assistant Respiratory Therapist

Pharmacist RN NP NP Student Other

If Other, please indicate professional role:

Please list all degrees

What course status are you applying for *
(Please select only one. See bottom of form for explanations.)

Provider status Associate Instructor Instructor

Registration fees

Attending physicians: $400
RNs, NPs, PAs, pharmacists, respiratory therapists, paramedics, residents,
fellows, medical & NP students: $300

Make checks payable to Vanderbilt University Medical Center. Checks, with the note that the payment is for FCCS Course registration, should be sent to the attention of:

Beverly Fletcher, VUMC FCCS Course Coordinator
1211 21st Avenue South, MAB Ste. 526
Nashville, TN 37212

CREDIT CARD INFO:
Note: You can call Beverly Fletcher directly at 615-936-2454 to provide your credit card payment information. If paying with internal 1180, please indicate department and who will be sending.

Please indicate how you will be paying:

Check Credit Card Departmental Payment (1180) 1180 will be sent from:________________

ENROLLMENT POLICY:

You will be informed of your acceptance to the selected course above by email. If a class is full, you will be informed of the next available course dates.

*Status Explanation

Instructor Status Prerequisites

  • Physicians - Critical Care Certification or Eligibility
  • Nurses - ACNP/CNS/CCRN or having a master's degree in Nursing with a specialization in Critical Care
  • SCCM membership
  • Complete two-day instructor course
Associate Instructor Status Prerequisites
  • Physicians & Nurses - Have considerable experience in Critical Care, but not meeting criteria for Instructor Status above
  • Must complete the two-day FCCS Provider course
  • SCCM membership
  • Associate Instructors can obtain Instructor status after two teaching experiences in FCCS Provider courses under the direction of FCCS Course Director
Provider Status Prerequisites
  • Any clinical professional who does not have significant experience/activity in critical care medicine
  • SCCM membership is NOT required.
  • Does need to complete two-day instructor course