STATE OF FLORIDA
STATE OF FLORIDA DEPARTMENT OF HEALTHBUREAU OF EMERGENCY MEDICAL OVERSIGHT CERTIFICATION OF TRAININGI, as medical director of , a Florida licensed EMS provider, hereby verify that the following paramedics have been trained to administer immunizations inaccordance with the requirements of Section 401.272(2)(b), Florida Statutes and 64J-1.004(5) Florida Administrative Code:NameCertification Number1. 2. 3. 4. 5. 6. 7. Signature Florida Medical License number STATE OF FLORIDACOUNTY OF Sworn to (or affirmed) and subscribed before me thisday of, 20, by. Personally KnownOR Produced IdentificationType of Identification.Signature of Notary(Seal) My Commission ExpiresDH 1256, 12/08 ................
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