Epstein Secrets

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

AL Cumulative Folder DATA PROCESSOR CONFIRMATION I confirm that the grade/course change has been implemented. SIGNATUR /A? y DATE PRINT NAME Copy - Office File EFTA01709722 WI LLLLL P.0. Box 3050 Bcca Raton, FL 33431.095..) Attn: Boca Matl Unit AV 01 048 153 993048229 A..€0OT 'ROYAL PALM BtACM, FL 35

ic (Print or Stamp) Add ACES, FLORIDA 33401 days after next Immunization appointment) Physician or Authorized Slgnat ed a schedule to I t o Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 cer

IGNATURE CF AREA ADMINISTRATOR L 0 DATE DATA PROCESSOR CONFIRMATION Sic 1/1,31ek DATE PBSD 0797 (REV 9/12/2001) ORIGINAL • Cumulative Folder Copy - Office File EFTA01709896 - A c:r=== Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 10 Student Report r and Name

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

RIGINAL - Cumulative Folder DATA PROCESSOR CONFIRMATION I confirm that the grade/course change has been implemented. siGvA PRINT NAME -oc DATE Copy - Office File EFTA01710228 JOENT NAME: tai :THDATE Verified by WW1 CoAlkalis: G Yes G No a No. What Typo Verification? iTHPLACE: Dad,p, RREN lie let