Subsequent Appearance

A candidate has appeared before a BCCI certification committee and received the recommendation “Subsequent Appearance” before another certification committee recommended.

Download the forms below if your previous certification committee recommended “Subsequent Appearance” and you originally submitted your application on paper. If you originally submitted through the online portal, you will complete the process through your original application in the certification portal.

Click the bar below to view the instructions for your application type.

Instructions for Paper Applicants

If you originally submitted your application on paper, please use the document and instructions for your subsequent appearance.

Instructions: 

  • Download and fill out the form below:
  • One (1) chaplain clinical contact narrative is required for subsequent appearance applications.
  • The clinical contact narrative must be a new Contact written within 12 months of submitting a subsequent appearance application.
  • The clinical contact narrative must be between 1000 and 3500 characters (approx. 170 to 700 words).
  • The narrative should demonstrate the applicant’s current level of functioning and provide descriptive examples of his or her professional competency. These narratives differ from the foci of many educational/CPE settings in that they are not to focus on the chaplain’s learning experience and personal growth.
  • The chaplain is encouraged to relate encounters that suggest respect for diversity and difference (e.g., care for a patient from a different faith tradition), as per competency PPS3.
  • At minimum, the narrative must explicitly demonstrate each of the competencies not met in the initial interview.  If the following three competencies were met in the initial interview, it is optional to address them again in Part 3 – 5 (below).
    • ITP2: Incorporate a working knowledge of psychological and sociological disciplines and religious beliefs and practices in the provision of spiritual care. Demonstrate this with an analysis (in Part 3 below).
    • PPS10: Formulate and utilize spiritual assessments, interventions, outcomes, and care plans in order to contribute effectively to the well-being of the person receiving care. Demonstrate this with a spiritual assessment (in Part 4 below).
    • PPS11: Document one’s spiritual care effectively in the appropriate records. Provide an example of patient-record charting. This may be a printout of an electronic medical record with all of the identifying information removed or it may simply be what the chaplain would have written in the medical record. Please be mindful of HIPAA regulations. All information sent must be de-identified in accordance with the requirements found in 45 CFR 164.514. Information that must be de-identified is at http://bcci.professionalchaplains.org/files/application_materials/hippa_regulations.pdf. Applications sent with HIPAA violations will be returned to the chaplain, who must then wait for the next application deadline to resubmit their materials.
  • Other competencies may also be demonstrated in the clinical contact and analysis. In the word-for-word encounter (Part 2 below), clearly identify where the competency is being addressed. Then, in the analysis (Part 6 below), elaborate on how it is demonstrated. For example: To demonstrate PPS5, the chaplain clinical contact (Part 2) would include spiritual care for a grieving person, noting “PPS5” in the margins or parentheses at the most salient moment(s) of such care, and the analysis (Part 6) would discuss how the chaplain’s intervention at that moment provided effective support.
  • The chaplain is encouraged to review the narrative with a mentor before submission.

Format of Chaplain Clinical Contact Narrative

Part 1:  Context, known facts, and personal observations

Part 2:  Encounter, word for word

Recount the chaplain clinical contact verbatim. Clearly note evidence of each competency that will be discussed below in Part 6, by recording the competency number (e.g., “PPS5”) in the margins or parentheses.

Part 3: Required analysis of chaplain clinical contact

Clearly identify how competency ITP2 is met. Also include self-evaluation, theological reflection, and identified ethical considerations.

Part 4: Spiritual assessment (PPS10)

Part 5: Documentation (chart note) (PPS11)*

Part 6: Further analysis in terms of additional competencies (Required as of April 2023)

Clearly identify how demonstrated competencies are met.


*A requirement with each of the two chaplain clinical contact narratives is to demonstrate PPS11: Document one’s spiritual care effectively in the appropriate records. The cover sheet indicates that the chaplain should provide an example of patient-record charting. This may be a printout of an electronic medical record with all of the identifying information removed or it may simply be what the chaplain would have written in the medical record. BCCI certification interview committees are using this information to determine if the competency is met and the chaplain can effectively use documentation. It is not to verify that the verbatim is within the needed dates or about an actual patient.

Names and birthdates are only two (2) of the eighteen (18) identifiers of the individual—or of relatives, employers, or household members of the individual—which must not be used in the narratives or the PPS11 example. It is this list of identifiers that BCCI uses to check for HIPAA violations.

  1. Names (Both first and last)
  2. All geographic subdivisions smaller than a state, including a street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census, (a) the geographic unit formed by combining all zip codes with the same initial digits contains more than 20,000 people, and (b) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people are changed to 000
  3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death; and all ages over 89 and all elements of date (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or over
  4. Telephone numbers
  5. Fax numbers
  6. E-mail addresses
  7. Social Security numbers
  8. Medical record numbers
  9. Health plan beneficiary numbers
  10. Account numbers
  11. Certificate/license numbers
  12. Vehicle identifiers and serial numbers, including license plate numbers
  13. Device identifiers and serial numbers
  14. Web Universal Resource Locators
  15. Internet Protocol addresses
  16. Biometric identifiers, including finger and voice prints
  17. Full-face photographic images and any comparable images
  18. Any other unique identifying number, characteristic or code (including a patient identifying/record number)

It is important that all of the listed identifiers be removed, and that no parts or derivatives of any of the aforementioned identifiers are left in the information submitted with a chaplain’s certification application.

Instructions for Online Applicants

If you originally submitted your application through the online portal, please use these instructions for your subsequent appearance.

Instructions:

  • One (1) chaplain clinical contact narrative is required for subsequent appearance applications.
  • The clinical contact narrative must be a new Contact written within 12 months of submitting a subsequent appearance application.
  • The clinical contact narrative must be between 1000 and 3500 characters (approx. 170 to 700 words).
  • The narrative must be completed in the online portal.
  • The narrative should demonstrate the applicant’s current level of functioning and provide descriptive examples of his or her professional competency. These narratives differ from the foci of many educational/CPE settings in that they are not to focus on the chaplain’s learning experience and personal growth.
  • The chaplain is encouraged to relate encounters that suggest respect for diversity and difference (e.g., care for a patient from a different faith tradition), as per competency PPS3.
  • At minimum, the narrative must explicitly demonstrate each of the competencies not met in the initial interview.  If the following three competencies were met in the initial interview, it is optional to address them again in Part 3 – 5 (below).
    • ITP2: Incorporate a working knowledge of psychological and sociological disciplines and religious beliefs and practices in the provision of spiritual care. Demonstrate this with an analysis (in Part 3 below).
    • PPS10: Formulate and utilize spiritual assessments, interventions, outcomes, and care plans in order to contribute effectively to the well-being of the person receiving care. Demonstrate this with a spiritual assessment (in Part 4 below).
    • PPS11: Document one’s spiritual care effectively in the appropriate records. Provide an example of patient-record charting. This may be a printout of an electronic medical record with all of the identifying information removed or it may simply be what the chaplain would have written in the medical record. Please be mindful of HIPAA regulations. All information sent must be de-identified in accordance with the requirements found in 45 CFR 164.514. Information that must be de-identified is at http://bcci.professionalchaplains.org/files/application_materials/hippa_regulations.pdf. Applications sent with HIPAA violations will be returned to the chaplain, who must then wait for the next application deadline to resubmit their materials.
  • Other competencies may also be demonstrated in the clinical contact and analysis. In the word-for-word encounter (Part 2 below), clearly identify where the competency is being addressed. Then, in the analysis (Part 6 below), elaborate on how it is demonstrated. For example: To demonstrate PPS5, the chaplain clinical contact (Part 2) would include spiritual care for a grieving person, noting “PPS5” in the margins or parentheses at the most salient moment(s) of such care, and the analysis (Part 6) would discuss how the chaplain’s intervention at that moment provided effective support.
  • The chaplain is encouraged to review the narrative with a mentor before submission.

Format of Chaplain Clinical Contact Narrative

Part 1:  Context, known facts, and personal observations

Part 2:  Encounter, word for word

Recount the chaplain clinical contact verbatim. Clearly note evidence of each competency that will be discussed below in Part 6, by recording the competency number (e.g., “PPS5”) in the margins or parentheses.

Part 3: Required analysis of chaplain clinical contact

Clearly identify how competency ITP2 is met. Also include self-evaluation, theological reflection, and identified ethical considerations.

Part 4: Spiritual assessment (PPS10)

Part 5: Documentation (chart note) (PPS11)*

Part 6: Further analysis in terms of additional competencies (Required as of April 2023)

Clearly identify how demonstrated competencies are met.


*A requirement with each of the two chaplain clinical contact narratives is to demonstrate PPS11: Document one’s spiritual care effectively in the appropriate records. The cover sheet indicates that the chaplain should provide an example of patient-record charting. This may be a printout of an electronic medical record with all of the identifying information removed or it may simply be what the chaplain would have written in the medical record. BCCI certification interview committees are using this information to determine if the competency is met and the chaplain can effectively use documentation. It is not to verify that the verbatim is within the needed dates or about an actual patient.

Names and birthdates are only two (2) of the eighteen (18) identifiers of the individual—or of relatives, employers, or household members of the individual—which must not be used in the narratives or the PPS11 example. It is this list of identifiers that BCCI uses to check for HIPAA violations.

  1. Names (Both first and last)
  2. All geographic subdivisions smaller than a state, including a street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of Census, (a) the geographic unit formed by combining all zip codes with the same initial digits contains more than 20,000 people, and (b) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people are changed to 000
  3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death; and all ages over 89 and all elements of date (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or over
  4. Telephone numbers
  5. Fax numbers
  6. E-mail addresses
  7. Social Security numbers
  8. Medical record numbers
  9. Health plan beneficiary numbers
  10. Account numbers
  11. Certificate/license numbers
  12. Vehicle identifiers and serial numbers, including license plate numbers
  13. Device identifiers and serial numbers
  14. Web Universal Resource Locators
  15. Internet Protocol addresses
  16. Biometric identifiers, including finger and voice prints
  17. Full-face photographic images and any comparable images
  18. Any other unique identifying number, characteristic or code (including a patient identifying/record number)

It is important that all of the listed identifiers be removed, and that no parts or derivatives of any of the aforementioned identifiers are left in the information submitted with a chaplain’s certification application.

If you have any questions regarding the Board of Chaplaincy Certification Inc. certification process, please contact the national office at 847.240.1014 or bcci@apchaplains.org.