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Get AHIA CHIAP Complaint Form 2018-2024

Against Which Complaint is Made) Name: Address: Phone: Email: Allegations of Complaint Provide details of your allegation (names, dates, and other specific information) relevant to your complaint. Supporting Documentation Attach supporting documentation to validate allegations referenced in the previous section of this complaint. Indicate the type(s) of supporting documentation provided. Please redact all sensitive information. Complaint Form must be mailed to: AHIA Certification Program.

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