Please answer your practice ability with relation to each of the specified patient populations or system symptoms. 

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* 1. Name

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* 2. Contact Phone Number

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* 3. Division/ Specialty

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* 4. Are you currently licensed to practice medicine in the Province of Ontario?

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* 5. If no, please provide details. 

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* 6. Do you have any restrictions listed on your certificate of registration?

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* 7. If yes, please provide details. 

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* 25. All professional staff should, at a minimum, be able to:
- Work in a COVID testing clinic
- Act as an entry way screener
- Provide administrative support
- Perform manual ventilation (bag squeezer)
If you are unable to fulfill these roles, please notify in the comment box below.

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