DIVISION SURGEON'S PROFIS MEDICAL OFFICER INFO SHEET
Name:	:
Rank:	DOR:
Specialty:	:
Work Address:	:
Pager:	:
E-mail address:
OfficeTelephone:	DSN:_____________ Comm:___________________
Home phone:	:
Home Address:	:
POC in an emergency:	:
POC telephone #:	:
Anticipated PCS/ETS:	:
Certification dates:	Boards:__________ ACLS:___________ ATLS:___________ PALS:___________ NRP:___________ ALSO:___________ Other:___________
Military Medical Training:	EFMB _________ Chem/Bio Casualty Care Course:____________ Other NBC Training: Other Military Med Training:
Prior Deployments:	:
Prior Military Service:	:
Profile:	:
Special Skills:	:

(If you are no longer PROFIS to this unit, then please forward this to the individual who has filled your position)

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Division Surgeon