ATLS REGISTRATION INFORMATION
Name: ______
Title: MD____ DO ____ Other: ______
Resident: (circle one) Y N
Specialty: ______
Employer:______
Refresher Course: Expiration Date/ATLS #: ______/______
Street Address: (course materials will be mailed to this address)
City, State, Zip: ______
Daytime Phone: ______
Fax Number: ______
Email address: ______
CIRCLE THE COURSE YOU WISH TO ATTEND:
Provider Courses
February 8-9, 2013
November 8-9, 2013
Refresher Courses
February 9, 2013
April 20, 2013
November 9, 2013
For more information contact the Trauma office:
Office: (913) 588-6536, Fax: (913) 588-5219
Advanced
Trauma
Life
Support®
2013
Provider/Refresher
Course Schedule
Sponsored by:
KansasCommittee on Trauma
AmericanCollege of Surgeons
in cooperation with
Trauma Services
University of KansasHospital
3901 Rainbow Blvd, MS 1011
Kansas City, KS66160
Course Objectives
The ATLS course is designedto train physicians who are in a position to provide the first hours of emergency care to trauma victims. The course utilizes didactic lectures and practical skill stations in order to effectively teach the principles of rapid, effective assessment and stabilization. Successful candidates will be awarded four-year certification. All courses are conducted according to the guidelines of the AmericanCollege of Surgeons.
Educational Objectives
The participant, upon completion of the ATLS course, will be ableto:
- Demonstrate understanding of concepts and principles of patient assessment and management.
- Perform skills necessary to diagnose and treat traumatic injuries.
- Establish management priorities in single & multiple trauma.
- Perform the initial assessment and management of trauma victims
Tuition/Registration fees:
- Provider Course: $850.00
- Refresher Course: $575.00
- Special pricing
- Physician Extender: $675.00 (P)/$375.00 (R)
- Resident: $400 (P)/$250 (R)
- Auditor: $150.00 – Provider only
Fees include continental breakfasts, lunches, course material, lab fees, other related costs and amenities involved in making this a pleasant learning experience.
**MANDATORY FOR REFRESHER COURSE**:
A copy of your current ATLS® card must accompany your enrollment application. Without it, we cannot accept your application.
To enroll, complete the entire course enrollment form and mail, with a check payable to University of Kansas Hospital, to the address below. Course material cannot be sent until the registration fee and enrollment form has been received. Course materials will be sent out 30 days prior to the course, unless payment and the registration form are received after this date.
SORRY, WE DO NOT ACCEPT CREDIT CARDS NOR CAN WE ACCEPT REGISTRATIONS BY PHONE.
University of Kansas HospitalTrauma Services reserves the right to cancel the program due to insufficient enrollment. In this event, you will be notified and your entire registration fee refunded.
**REFUNDS AND CANCELLATIONS**:
Absolutely NO refunds will be issued if participants can not attend the class in which they are registered. However, we do allow substitutes in their place and allow them to register for a course offered on a different date.
Refunds will only be issued if we cancel the class.
CME Credit:
The AmericanCollege of Surgeons is accredited by the Accreditation council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The AmericanCollege of Surgeons designated this educational activity for a maximum(Provider-19, Refresher- 5) AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation to the activity.
RETURN WITH FEE TO:
University of KansasHospital
Trauma Services
3901 Rainbow Blvd
Mail Stop 1011
Kansas City, KS66160
Checks must be made out to University of Kansas Hospital
In accordance with the Americans with Disabilities Act, please advise Trauma Services if you have any disability that requires special materials and/or services so that appropriate personnel can be advised.