med_cert.pdf
-
Upload
coleenllbusa -
Category
Documents
-
view
218 -
download
0
Transcript of med_cert.pdf
-
7/25/2019 med_cert.pdf
1/1
DFllVER
'SUCENSAPPLIC.'.NT
1.
Pfryo ie iordrnotmallyfllto
B
~ P P E R L I M B S A M P l l T
T E D LEFTOR
R I G H T A R M W I T H P R O S T H E ~ S
B LOWER LIMBS - AMPIJl ATED B LEFTOR B RIGHT LEG W1TK f f i O S n i ~ S
~ ~ v ; ; : ~ ; Z ~ R c : ~ ~ : i z ~ o ~ E I T H E R 0 LEFTOR 0RIGHT
B :ARTIALLYBl.IND
O L O R
Bl.IND
t NEEOSPROPERCORRECTIVEGLllSSES
B : s
PEECHIHEARltlGIMPAIRED
NEEDS HEARING DEi/iCE
oruERF INDINGS(d Ssaf'I)
VA. . DOH YfOBFIFT ffNU51Q. .YEBOH lll fQ.UfQf(S . .NCE