Last revised: 06 Feb 2026
Provider Logo (must be included)
[All the following information must be included where applicable].
STATEMENT OF ATTENDANCE or COMPLETION [GP’s full name] [GP’s RACGP member number]
Attended / Completed the [Approved activity title] [Activity number] This activity has been approved for the following hours and types. [add below RACGP approved activity logo with correct hours]
This activity has been approved for: [Procedural skills/cardiopulmonary resuscitation/rural procedural training grant/specific interest requirement]
Conducted by [Provider name] on [date/s]
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