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<br />SOUTHEAST TEXAS TRAUMA REGIONAL ADVISORY COUNCIL (SETTRAC) <br />ADVANCED TRAINING AUTHORIZATION <br /> <br />Course Type: (Circle One) BTLS PHTLS PEPP SLAM PALS Other: <br /> <br />Dates: <br /> <br />to <br /> <br />Location: <br /> <br />Organization: <br /> <br />Name (print) <br /> <br />I <br /> <br />Certification Level <br /> <br />Si2Dature <br /> <br />The above-named individuals successfully completed the indicated course. <br /> <br />Printed Name of Course Coordinator <br /> <br />Signature of Course Coordinator <br /> <br />----------------------------------------------------------------- <br /> <br />I am the Medical Director for the above-named organization. The individuals listed above are <br />members of that organization and attended the course with my approval. <br /> <br />Signature of Medical Director <br /> <br />Printed Name of Medical Director <br />