Medical Assistant Certification 

_________________________________________________________, is a medical assistant employed by this practice. 
(Medical assistant)

_________________________________________________________________has successfully completed the required 
(Medical assistant)

training in the following areas:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________



The training, which I personally administered and observed, began on _______________________ and was completed on ___________________.


_________________________________
(Physician Signature) 

_________________________________
(Date)