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Get Washington Practitioner Application Fillable

When a request is received, send a copy of the completed application, making sure that all information is complete, current and accurate. Please sign and date pages 12 and 14. Please document any YES responses on the Attestation Question page. Identify the health care related organization(s) to which this application is being submitted in the space provided below. Attach copies of requested documents each time the application is submitted. If changes must be made to the completed application, s.

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