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GIVEN NAMES TITLE MR/MRS/MS/MISS/OTHER DATE OF BIRTH RESIDENTIAL ADDRESS TOWN/SUBURB STATE POSTCODE TEL HOME TEL WORK TEL MOBILE EMAIL PART A THEORETICAL COMPONENT VASCULAR INTERVENTIONAL IMAGING ANGIOGRAPHY LEVEL 1 CERTIFICATION VASCULAR LEVEL 1 EXAMINATION TAKEN IN SELECT MONTH MAR YEAR TAKEN 2020 PART B CLINICAL COMPONENT STATEMENT OF CLINICAL EXPERIENCE IN ANGIO VASCULAR I certify that I have performed over 150 vascular angiography examinations within the 12- month period between and....
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