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Application for Emergency Medical Services Certification
16. EXAMINATION DATE: Fill in the date that you will be taking the NYS certifying exam. This date will be provided by the Instructor/Coordinator. 17. Read the statement and sign the application (if able) as you normally sign your name, and write in today's date. You are responsible for the statement's truth and accuracy.
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Form DOH-4376 - Mail-in Application for Copy of …
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UNDOCUMENTED/ILLEGAL ALIENS TREATMENT …
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