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(required for new school entrants and chilúen aœ 4-7 yrs) [2 with glasses a Motor IMMUNIZATIONS 'Rotavirus - DATES Acuity Right / Left / Strabismus a No ayes ICD-g Code Appt. date: Dental City Fax CIR Number of Child Full physical activity Influenza MMR Våricella Meningococcal Other, specify: ASSESSMENT Vision Date ................
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