This government document is issued by Podiatric Medical Examiners Board (0140) for use in Oklahoma
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https://www.google.com/url?client=internal-element-cse&cx=011016168438751653346:hresk_9zb-o&q=https://www.okmedicalboard.org/anesthesiologist_assistants/download/505/ANA_Form_4_Recom.pdf&sa=U&ved=2ahUKEwiV7LPCtMeUAxXkUaQEHdSUHjs4HhAWegQICRAB&usg=AOvVaw34jfjwjq1L9CmtrWwwD0qb