By the local health bureau or the relevant departments of medical institutions. The specific process is as follows:

1. Prepare relevant materials, including my identity certificate, education certificate, vocational skill certificate and health certificate.

2. Submit an application to the local health bureau or relevant departments of medical institutions and pay relevant fees.

3. Participate in the training and pass the exam, and receive the certificate after passing the exam. Note: The specific procedures may be different in different regions, so it is recommended to consult relevant local departments.