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Director Signature. List all ambulance services with which you have had medical command authorization in the past five years. If necessary please use a separate sheet of paper. Name of Service Dates with Service ALS Service Medical Director Telephone Number 2. Has your medical command authorization ever been restricted If yes please provide a full description of each restriction on a separate sheet of paper including name of ALS service and ALS service medical director. YES Restricted for Initi ...

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