Epstein Secrets

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sician or Clinic Name: (Print or stamp) Address: Expiration Date: (15 days after ant inuntuthafteei appointment) hvsician or ignature: Date: Permanent Medical Exemption PART C For medically contraindicated immun exemption: DOE Code 3 tions, list each vaccine and state valid clinical reasoning or evidence for I ce

2 10 Points Earned 0 2 Data Run Date: 04/30/2004 0054696 685000537 EFTA01710017 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SSS Science Student and Parent Report Grade 10 NAME: ID: SCHOOL: 2331a0 DISTRICT: SO-PALM 8EACH A 11 HIGH The Flerida Department el Education beSeves that El Fl

• (Print or Stamp) Address: Expirati0n Date' _Olitlazufttstualimaadzatisin atipSathunD *LI Physician or Authorized Signature. Date. Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

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ic Name: 05•days after next immuilization.appoiutrnent) (Print or stamp) . . _ . . . • Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

0054490 685000916 EFTA01710084 Spring 2004 NAME: . , Florida Comprehensive Assessment Test (FCAT) ID: Meth CompreM1ensl.ee Assessment Test SSS Science Student and Parent Report Grade 10 SCHOOL: DISTRICT: 2331•ROYAL PALM BEACH HIGH 50-PALM BEACH The Florida Department of Education believes that El Flo

rvice Address: Riviera Bea L 33404 Phone: Expiration Date: (IS days after next Physician or Authorized Signatu A. 41/21-4goo/ w 7 3.0) •, Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 / c