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