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[PDF File]Form I-693, Report of Medical Examination and Vaccination ...
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traditional 5-word per trial list or optionally using 10-words per trial to minimise any ceiling effect. All 3 trials must be administered irre-spective of the number correct on the first trial. Administer at the rate of one word per second. Please choose EITHER the 5 or 10 word list groups and circle the specific word list chosen for this test.
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[PDF File]Sport concussion assessment tool - 5th edition
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FORWARD THIS COPY TO PERSONNEL OFFICE VIA COMMAND ONLY ON COMPLETION OF LEAVE. S/N 0104-LF-703-0656 PART 1 1. Completion of this form must be in ballpoint or typewriter. The form must be completed in triplicate with all copies legible. 2. Print or type the appropriate date in block 1 and 3 through 21. Leave block 2 blank. 3.
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[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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Generalized Anxiety Disorder 7-item (GAD-7) scale Over the last 2 weeks, how often have you been bothered by the following problems? Not at all sure
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[PDF File]FMCSA Medical Examiner Handbook
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19. REHABILITATION POTENTIAL - CHECK ü ONLY ONE 17. PHYSICIAN ORDERS 14. PATIENT IS CAPABLE OF ADMINISTERING HIS/HER OWN MEDICATIONS WEIGHT 1. Independently BLOOD PRESSURE TEMPERATURE PULSE RATE CARDIAC RHYTHM 7. ATTENDING PHYSICIAN 9. EVALUATION AT (Description and code) 10. For the purpose of determining my need for TITLE XIX …
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Medical Examiner Handbook ... Blood Pressure/Pulse 36 Urinalysis 38 ... The medical examiner is responsible for certifying only drivers who meet the physical qualification standards. Certification cannot exceed 2 years, and at the discretion of the FMCSA medical examiner,
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[PDF File]INSTRUCTIONS FOR COMPLETING MA-51 MEDICAL …
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completed this application based only on information that the applicant provided to me or authorized me to obtain or use. Parts 5. - 10. of this form must be completed by the civil surgeon. Preparer's Signature. Date of Signature (mm/dd/yyyy) Preparer's Signature 8. B.
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List blood pressure medications only