Epstein Secrets

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

isons from year to year. Reading Comprehension Scale Scores range from 491 to 810. Mathematics Problem Solving Scale Scores range from 497 to 814. The National Percentile Rank and Stanine indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanines ra

nic Name: (Print or stamp) Expiration Date: (t5 days after next immunization appointment) 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

llows for comparisons from year to year. Reading Comprehension Scale Scores range from 527 to 817. Mathematics Scale Scores range from 568 to 863. The National Percentile Rank and Stanine Indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanlnes ra

• (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

isons from year to year. Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Scale Scores range from 517 to 830. The National Percentile Rank and Stanine Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanlnes ra

an or Clinic Name: (Print or stamp) Address: Expiration Date: (r9 dart after nest humanization appo 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

isons from year to year. Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scale Scores range from 527 to 836. The National Percentile Rank and Stanine Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanlnes ra

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

isons from year to year. Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Scale Scores range from 517 to 830. The National Percentile Rank and Stanine indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanines ra

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

allows for comparisons from year to year. Reading Comprehensbn Scale Scores range from 527 to 817. Mathematics Scale Scores range from 568 to 863. The National Percentile Rank (NPR) and Stanine indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. The P