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Certification Extension Request Form

INSTRUCTIONS FOR USE

The CME Completion Form is to be completed by Paramedics following the completion of any approved clinical CME activity. This form is to be submitted to NWRPCP prior to the CME deadline date as outlined in the CME Program and Catalogue; December 15th or next business day. Please complete in as much detail as possible to provide context for full analysis. Note: please don’t include any patient health information (PHI) in your entries.

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For Office use only

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