-HOUR INITIAL REPORT - NC DHHS
DHSR/HCPR Form No. 4501 Rev. 06/24/2014 Additional information available at www.ncnar.org N.C. Department of Health Care Personnel Registry Health & Human Services FAX: (919) 733-3207 -HOUR INITIAL REPORT Phone: (919) 855-3968 24 Division of Health Service
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