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  • CPR Request Form Online
    Please complete the below form.
     
    Officer's First name:
    Officer's Name:
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    Shift:
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    Date of Request:
    Recipient Name:
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    Incident/Reason:

    (Please describe, in detail,

    what the problem is,

    what the specific need is,

    and what the cost to supply

    will be. Also, if applicable,

    what the recipient's plan is

    to avoid recurrence of

    issue.

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