Edit a Badge

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This form is only to be used to change the current details of a badge wearer (i.e. changing last name, data correction of an employee number or date of birth).

	* denotes required fields
*Clinic Name
*Primary Contact
*Clinic Phone Number
*E-Mail

Change Details for the Following Employee:

Current Info :
Updated Info :

*Employee Name

*SS/Employee ID

*DOB (XX/XX/XXXX)

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