Get the doh 4135 form

Health. state. ny. us/nysdoh/ems/policy/09-03. htm Automated External Defibrillator Manufacturer of AED Unit Model of AED Pediatric Capable Is the AED Yes No Number of Trained PAD Providers Number of AEDs Emergency Health Care Provider Name of Emergency Health Care Provider Hospital or Physician Name of Ambulance Service and 911 Dispatch Center Name of 911 Dispatch Center and Contact Person County Authorization...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • Fax
  • Email
  • Add Annotation
  • Share
doh 4135
Rate This Form