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Charles D. Anime, PM, ACFAS, CDs Diplomat, American Board of Pediatric Surgery Diplomat, American Academy of Wound ManagementPatient Information Sheet (Confidential) Name: Date of Birth: Age: Address:
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The Diplomate of Form American is a designation indicating that an individual has met specific qualifications and standards set by an American certifying board in their profession.
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Professionals seeking certification or recertification from an American certifying board are typically required to file the Diplomate of Form American.
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The purpose of the Diplomate of Form American is to validate the credentials and competencies of professionals in their field, ensuring they meet established national standards.
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The information required includes personal identification, details of educational qualifications, work history, professional licenses held, and any continuing education credits.
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