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Maintenance of Certification Plan Application Form

Please complete all applicable fields.

Proactively submit this form to request approval for activities which may fulfill MOC requirements.

Paramedic Information

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Track 1
  • No documentation required, no need to submit this form
Track 2
  • Complete Simulated Patient Encounter Session
  • Submit Alternate Clinical Experience or CME for approval
Track 3
  • Individualized process
  • Requires both Service and CPER approval

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TRACK 2: ALTERNATE CLINICAL EXPERIENCE (Approx. amount & context)

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TRACK 3: Administrative Certification

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All statements must be true

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