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

my knowledge. (66)DATA /GUARDIA DATE REV:10636 (REV 416,2001) page 2 of 2 EFTA01709726 12t r emae (Form: 23(3 SSN: NA 2004 Ain No 0017 ASVAB RV RESULTS ASVAB Results 12th Credo Standard Scores 12th Grade Standard Score Bands Percentile Scores 12th 12th 12th Gtaile Grad. Grade

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

s earlier e Date: EFTA01709864 12th Gr Female (Form: 23G) SSN: NA Test Date: Nov 22, 2004 Royal Palm Beach Hs Royal Palm B FL Prht N4 0326 ASVAB sum ARMED SERVICES VOCATIONAL APTITUDE BATTERY. ARV RESULTS • ASVAB Results 12th SteGtrillaerd Scores 12th Grade Standard Score Bands Percenti

Clinic Name: Expiration Date: (Print or sump) (15 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 - -

) Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL Pam 19.0003 ASVAB SUM ARMED SERVICES VOCATIONAL. APTITUDE BATTERY ARY RESULTS ASVAB Results — 11th Standard Scores 11th Grade Standard Score Bands Percentile llth Made Females Scores ITO Gads Mat 11th Grade Students

Clinic Name: Expiration Date: (Print or sump) (15 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 - -

) Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL Pam 19.0003 ASVAB SUM ARMED SERVICES VOCATIONAL. APTITUDE BATTERY ARY RESULTS ASVAB Results — 11th Standard Scores 11th Grade Standard Score Bands Percentile llth Made Females Scores ITO Gads Mat 11th Grade Students