Get Doh 5064

The Doh 5064 form is a crucial document for those seeking recertification in the Continuing Education Recertification Program offered by the New York State Department of Health. This guide will provide clear, step-by-step instructions on how to complete the form efficiently and accurately online.

Follow the steps to complete the Doh 5064 form:

1. Press the ‘Get Form’ button to access the Doh 5064 form and open it in your preferred editing tool.
2. Begin filling out the form by entering your EMT number and social security number. Ensure to separate the social security number using dashes as illustrated on the form.
3. Next, input your last name, middle initial, and first name in the respective fields provided. It is important to print neatly in upper case letters to avoid any processing delays.
4. Fill in your address, including the city, state, and zip code to help verify your identity and location.
5. Enter the agency code of your participating CME agency. This step is essential as it associates your training with the correct agency.
6. Complete the required hours section. Enter the total hours you have earned in the appropriate categories listed on the form, ensuring accuracy.
7. Obtain a signature from the CIC and fill in the CIC number, confirming that your hours have been validated by your agency.
8. Once all fields are completed accurately, you can save your changes, download the filled form, print it for your records, or share it as required.

Ready to submit your application? Complete the Doh 5064 form online today.