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Course Dates and Times (EST)
  • June 4, 5 and 7, 2024
Please complete this form by May 20, 2024 to participate in the virtual prep course for the National Board for Respiratory Care (NBRC) exam.
Learn more about the American Lung Association Asthma Educator Institute.

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* 1. First name

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* 2. Last name

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* 3. Credentials (MD, RN, MPH, CHES, etc.). If none, enter N/A.

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* 4. Practice/Organization Name

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* 5. TIN Number (if not applicable, put N/A)

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* 6. Practice Medical Director (if applicable):

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* 7. Mailing Address (where you would like to receive course materials). Please do not list a PO Box.

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* 8. Email Address

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* 9. How many asthmatic patients do you treat in your practice? If none, please enter "N/A"

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* 10. How will you, or your practice, use the asthma training?

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* 11. Will your practice bill Healthfirst members for in-person visits with your
Certified Asthma Educator?

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* 12. This program is approved for 14.0 contact hours on Continuing Respiratory Care Education (CRCE) credit by the American Association for Respiratory Care (AARC). Please chose an option below:

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* 13. This program is approved for 14.0 credit hours - AMA PRA Category 1 for Physicians and RNs, Rehoboth McKinley Christian Health Care Services (RMCHCS). Please choose an option below:

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* 14. Are you in need of any special needs or considerations? (i.e., hearing impaired, visually impaired)

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