Surge Sort Support:
Continuous Integrated Triage

Course Registration Form

PARTICIPANT INFORMATION
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JOB AND DISASTER RESPONSE FUNCTIONS (Check All That Apply)
Corporate Officer POSITION: Administration
Emergency departmental staff Chaplain
Medical staff Beahavioral health, social services
Nursing staff Health education
Safety and security Public information
Human resources Medical Reserve Corps
Risk management Other:

EDUCATION (Check All That Apply)
RN MPH MD or DO EMT or Paramedic
ARNP MSW PhD, EdD, PsyD Emer Mgmt Degree
Other Nursing:
       		 MA or MS JD or other Law Bachelor's Degree
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PROFESSIONAL LICENSES (Check All That Apply)
Advanced Registered Nurse Practitioner (ARNP) License Psychologist
Registered Nurse (RN) Psychologist
Licensed Practical Nurse (LPN) School Psychologist
Certified Respiratory Therapist Dietition/ Nutritionist
Registered Respiratory Therapist Nutrition Counselor
Respiratory Care Practitioner Critical Care Licensed Midwife
Respiratory Care Practitioner Non-Critical Care  
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