KRHOP

     

TO:                 Hospital CEOs/Administrators

FROM:           Sara Roberts, Kansas Department of Health and Environment

                        Chad Austin, Kansas Hospital Association

RE:                 Advanced Trauma Life Support (ATLS) Funding

DATE:           March 15, 2011

We are happy to announce that the Kansas Rural Health Options Project is continuing its support for trauma education and the Advanced Trauma Life Support training to our rural health providers.

The Kansas Rural Health Options Project is providing 20 scholarships up to $1,000 for rural physicians to participate in the Advanced Trauma Life Support course.  These scholarships will be provided to qualified applicants on need as well as on a first-come, first-serve basis.  Early applications are encouraged with applications received by April 15, 2011 receiving higher priority.  It is expected that the scholarships will be used prior to December 31, 2011. 

Interested individuals should submit a formal letter of request that includes the physician’s name and email address, license number, course and hospital name along with the attached request form to Dan Leong, Director, Emergency Preparedness; Kansas Hospital Association; 215 SE 8th Avenue; Topeka KS 66603. 

For further information contact Debbie Hall or Dan Leong at the KHA office, (785) 233-7436 or dleong@kha-net.org.  We strongly encourage Critical Access Hospitals to offer this great trauma training opportunity to their rural physicians.

ATLS Scholarship Request Form

                                                                                                                                                                                                                                                                                               

Please complete the following information.                                                                                                                                  

Demographics

Credentials (check one)

  ARNP                    PA                          DO                          MD

Provider Name:  __________________________________________________

Provider Organization:  ____________________________________________

Organization Mailing Address (city & zip):  ______________________________

Phone:  _______________________________

Email:  ________________________________

In which Regional Trauma Council area do you provide services?  (Check all that apply)

  NERTC                              NCRTC                             NWRTC

  SERTC                              SCKTR                              SWRTC

ATLS Course Information


Please provide the following information for the ATLS class you plan to attend. 

ATLS Course Location:  ______________________________

ATLS Course Date:  _________________________________

Registration cost:  $___________

ATLS Scholarship Budget Summary


If you need additional funding, please list.  Reimbursement will be at the state rate.

Travel (miles)

Lodging

Note:  If you are a recipient of the scholarship, you will be required to submit a certificate of completion.

Note:  This application must be fully completed to receive a scholarship.