Parent or Guardian *Mkt t (Jr rIS11111.0% . DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES EALTH EXAMINATIONS Date Phone Race LiifM r Sek—e— Birliadate A. HEALTH EXAMINATION Normal-N; Abnormal- A 1. Appearance N A 2. Ski/Nose a Head/Scalp 4. Eyes 5. Visual Acuity (R 8 L) 6. Ears 7. Audito