Replacement Diploma Request Please complete this form to request a replacement or duplicate diploma. Name at the time of graduation(Required) First Last Name you wish to have printed on diploma(Required)If your name has changed from the time of graduation, you must submit legal documentation to verify. Please email a copy of your updated Social Security card or U.S. passport to diplomas@ultimatemedical.edu.Program graduated from(Required)Basic X-Ray with Medical Office ProceduresDental Assistant with Expanded FunctionsHealth and Human ServicesHealth Information TechnologyHealth Sciences Basic X-Ray with Medical Office ProceduresHealth Sciences Dental Assistant with Expanded FunctionsHealth Sciences Healthcare Technology & SystemsHealth Sciences Medical Administrative AssistantHealth Sciences Medical AssistantHealth Sciences Medical Office and Billing SpecialistHealth Sciences Medical/Clinical Laboratory AssistantHealth Sciences Patient Care TechnicianHealth Sciences Pharmacy TechnicianHealthcare ManagementHealthcare Technology & SystemsMedical Administrative AssistantMedical AssistantMedical Billing and Coding (Diploma)Medical Billing and Coding (Associate Degree)Medical Office and Billing SpecialistMedical/Clinical Laboratory AssistantNursingNursing AssistantPatient Care TechnicianPharmacy TechnicianPhlebotomy TechnicianDate of graduation(Required) MM slash DD slash YYYY Phone(Required)Student ID(Required)
