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

ate Standards la. 1 Elèv sa a gen yon ti siksè tou piti nan matyè ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. Sètifika FCAT Elèv ki fè nbt 5yèrn Nivo oswa elèv ki fè gwo nbt ki pi plis pase 400 nan syans ap resevwa Sètifika pou Siksè. Yo bay tout elèv ki fè nbt 5.5 oswa 6 ak elè

• (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

ate Standards la. 1 Elèv sa a gen yon ti siksè tou piti nan matyè ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. Sètifika FCAT Elèv ki fè nbt 5yèm Nivo oswa elèv ki fè gwo nbt ki pi plis pase 400 nan syans ap resevwa Sétifika pou Siksè. Yo bay tout elèv ki fè not 5.5 oswa 6 ak elèv

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

ate Standards la. 1 Elèv sa a gen yon ti siksè tou piti nan matyè Id gen difikilte ladan yo nan egzamen Sunshine State Standards la. Sètifika FCAT Elèv ki fè nót 5yem Nivo oswa elèv ki fè gwo not ki pi plis pase 400 nan syans ap resevwa Sètifika pou Siksè. Yo bay tout elèv ki fè nót 5.5 oswa 6 ak elèv