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Get DOH-4231 2012

Erstood that false statements or documents submitted with the intent to falsely recertify may be grounds for revocation of certification and applicable civil and criminal penalties. It is also understood that the Bureau of Emergency Medical Services or its designee may conduct an audit of the activities listed herein at any time. This form must be mailed and postmarked no less than 45 days prior to your current expiration date! ________________________________________ _________________________.

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