old-Application for
Family Medicine (FM) CORE Exception to IP Certification

There are two requirements to obtain a FM CORE Exception to IP Certification:
1. Points in each Question #4,5,6,7
2. A reference from a Master Instructor in Question #8

Applications are processed within 30 days.
Asterisk denotes required answer.

Question Title

* 1. Please enter date

Select the date below:

Date

Question Title

* 2. Please enter your name

Question Title

* 3. Please identify your profession:

Nursing professional

Paramedical

Resident

Physician Assistant

Medical student

Other (please specify)

You must answer affirmative for each Question #4,5,6,7 in order to be certified for an Exception to FM CORE IP and proceed to the next question.

Question Title

* 4. Please confirm that:
(1 point)

I have at least two years of FM CORE POCUS scanning experience

Please state number of years

Question Title

* 5. Please confirm the number of scans supervised by an FM CORE Independant Practitioner or FM CORE Master Instructor certified for each FM CORE module.
(Parenthesis show # of required scans)
(8 points)

I have collected (25+) Cardiac sub-xiphoid scans

I have collected (25+) Aortic scans

I have collected (25+) Abdo (RUQ) scans

I have collected (25+) Abdo (LUQ) scans

I have collected (3+) Abdo (male pelvis) scans

I have collected (25+) First TM obstetrics scans

I have collected (5+) Pleural effusion scans

I have collected (5+) Pneumothorax scans

Question Title

* 6. Have you completed at least one CPoCUS/non-CPoCUS accredited FM CORE POCUS course as a participant? A minimum of one course is required.
(1 point)

Yes

You must list the course name(s) and date(s).

Question Title

* 7. Have you taught at least one CPoCUS/non-CPoCUS accredited FM CORE course as an instructor or taught individuals? A minimum of one course is required.
(1 point)

Yes

You must list course name(s) and date(s) or individuals

Question Title

* 8. Please provide a short reference from a FM CORE Master Instructor. (1 point)

I have provided an online reference by sending the following link to the Master Instructor:
reference letter

I have provided a hardcopy of a reference letter in Question #9

Question Title

* 9. Attach additional material (if applicable).

Please label your file with your full name

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 10. Attach additional material (if applicable).

Please label your file with your full name

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

old-Application for Family Medicine (FM) CORE Exception to IP Certification

Question Title

* 1. Please enter date

Question Title

* 2. Please enter your name

Question Title

* 3. Please identify your profession:

Question Title

* 4. Please confirm that:(1 point)

Question Title

* 5. Please confirm the number of scans supervised by an FM CORE Independant Practitioner or FM CORE Master Instructor certified for each FM CORE module. (Parenthesis show # of required scans)(8 points)

Question Title

* 6. Have you completed at least one CPoCUS/non-CPoCUS accredited FM CORE POCUS course as a participant? A minimum of one course is required.(1 point)

Question Title

* 7. Have you taught at least one CPoCUS/non-CPoCUS accredited FM CORE course as an instructor or taught individuals? A minimum of one course is required.(1 point)

Question Title

* 8. Please provide a short reference from a FM CORE Master Instructor. (1 point)

Question Title

* 9. Attach additional material (if applicable).

Question Title

* 10. Attach additional material (if applicable).

old-Application for
Family Medicine (FM) CORE Exception to IP Certification

* 4. Please confirm that:
(1 point)

* 5. Please confirm the number of scans supervised by an FM CORE Independant Practitioner or FM CORE Master Instructor certified for each FM CORE module.
(Parenthesis show # of required scans)
(8 points)

* 6. Have you completed at least one CPoCUS/non-CPoCUS accredited FM CORE POCUS course as a participant? A minimum of one course is required.
(1 point)

* 7. Have you taught at least one CPoCUS/non-CPoCUS accredited FM CORE course as an instructor or taught individuals? A minimum of one course is required.
(1 point)