Epstein Secrets

• (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

. Sétifika - Dapré nät elév yo få nan "Sunshine State Standard? pou FCAT la, yo ka bay yo sétifika pou sa yo akonpli. Pou lekti ak Matematik, elév ki fé gwo nät ki klase palomeas yo nan SOff, nivo, resevwa sétifika. Pou redaksyon, tout elév ki fé nät 5.5 ak 6 ak tout elev Klas 40", ki få nät 5, 5.5, ak

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

yon ti siksé tou piti nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. Shtifika FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo nöt kl pi plis pase 400 nan syans ap resevwa Sétifika pou Siksé. Yo bay tout elév kl fé nät 5.5 oswa 6 ak elév klas katriyém ki fé nöt 5, 5.5, ak

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

n ane. Sötifika • Dapré nät elév yo fé nan "Sunshine State Standar pou FCAT la, yo ka bay yo sétifika pou sa yo akonpll. Pou lekti Matematik, elév ki fé gwo nät ki klase pélibmans yo nan 5véril nis resevwa sétifika. Pou redaksyon, tout elév ki fe not 5.5 ak 6 ak tc elév klas 41"" ki fé nät 5, 5.5, ak 6