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I hold a valid College certification in Prescriptive Authority. I have completed a course in NCLS or ACLS within the past two years. Certification in Aesthetic Procedures PRP Injections to the Face and Other Skin Areas for Aesthetic Purposes and attach a copy of the corresponding course completion certificate s. Applicant s Signature Yes No Attached On file Date Applied yyyy/mm/dd FOR OFFICE USE ONLY Full Registrant Rx Authority date ACLS / NCLS Evidence of Course completion Signature...
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