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APPLICATION FOR RENEWAL OF LICENSE TO …

Healthcare Professions Division Tel : +973 17 11 33 29 eMail : Website : Box : 11464, Manama, kingdom of bahrain Form 6: APPLICATION for RENEWAL of professional LICENSE For office use: APPLICATION number: APPLICATION FOR RENEWAL OF LICENSE TO PRACTICE AS A HEALTH PROFESSIONAL Part I- To be completed by the applicant _____ LICENSE / Registration Number Expiry Date of Current/Last LICENSE Profession: (Please tick one) Doctor General Specialist Consultant Dentist General Specialist Consultant Nurse General nurse Practical nurse Specialist nurse Midwife Allied Dental hygienist Dietician ECG technician Laboratory Medical Representative Allied (cont.) Nuclear medicine technician Optometrist Pharmacist Pharmacy Technician Physiotherapist Prosthetist Public health inspector Radiographer Respiratory technician Speech/Audio therapist Specialty (please specify if applicable)_____ Type of Employment Full Time Part Time 1.

Healthcare Professions Division Tel : +973 17 11 33 29 eMail : hcp@nhra.bh Website : www.nhra.bh P.O. Box : 11464, Manama, Kingdom of Bahrain Form 6: Application for renewal of professional license For office use: application number:

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