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Online Forms

Self Report Form

Report an incident
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Patch Failure

Report a patch failure
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CME Preapproval

Request approval for external CME credits
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Clinical CME Completion

Please complete this form to have your CME hours added
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MedicASK

Post a question for our Medical Panel
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Certification Extension Request Form

Request an extension to complete requirements
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Service Forms

Request for Certification

Initial Certification

Updated Aug 2024

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Request for Certification

Return to Practice
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Cross Certification Form

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