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

ki dekri nivo siksè elèv yo pote nan kontni yo teste nan egzamen lekti ak matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a se nivo 1. Piske yo poko detèminen nivo siksè nan egzamenn syans tan, yo klase nbt pou syans lan swivan si li tonbe pi ba. nan mitan oswa pi wo yon tyé pèfbmans elèv toupat

• (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

ki dekri nivo siksè elèv yo pote nan kontni yo teste nan egzamen lekti ak matematik FCAT la. Pi gwo nivo a se nivo 5 epi pl plti nivo a se nivo 1. Piske yo poko detèminen nivo siksè nan egzamenn syans lan, yo klase not pou syans lan swivan si li tonbe pi ba, nan mitran oswa pl wo yon tyè pèfbmans elèv toupa

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

ki dekri nivo siksé elév yo pote nan kontni yo teste nan egzamen lekti ak matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a se nivo 1. Piske yo poko detéminen nivo siksé nan egzamenn syans Ian, yo klase nät pou syans Ian swivan si Ii tonbe pi ba, nan tuttan oswa pi wo yon tyé pétbmans elév toupa