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EX RACIAL/ETHNIC GROUP MVVhite, Not Hispanic O Black, Not Hispanic U Hispanic O American STUDENT NU
essure (I) Normal=N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes 5. Visual Acuity (R & L) R Aro& °row 6. Ears 7. Auditory Acuity (11 Et L) 8. Nose / Throat 1 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen V 1
0 RACIAL/ETHNIC GROUP lEI"White, Not Hispanic Black, Not'Hispanic 0 Hispanic 0 American Indian/Nati
e (✓) Normal=N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes • . 5. Mural Acuity (R & L) . 6. Ears Ii. 7. Ati0ttory Acuity1R & L) — 8. Nose / Throat 9. Mouth, Teeth and Gums 10. Chest / Lungs 1 i. Heart - 12. Abdomen 13. Geni
EX RACIAL/ETHNIC GROUP 0 White. Not Hispanic 0 Black. Not Hispanic SubNci TolChor 114A SPFI (RIO
dings, by number 1. Appearance C < r. 2. Skin/Nose ../ 3. Head/Scalp / 4. Eyes 5. Visual Acuity IR & Ll . / 6. Ears / 7. Auditory Acuity (R & L) / 8. Nose / Throat / 9. Mouth. Teeth and Gums /,.." 10. Chest / Lungs / 11. Heart / 12. Abdomen / 4". 13. Genitals and Anus / 14. Musc
SEX: RACIAL/ETHNIC GROUP: G Mao Not Hispanic G Black Not Hispania -c Dale First Entered This ()kirk'
ure (1) Normal-N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes J 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 8. NOSe / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13. Genitals and Anus
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