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Get and Sign Ability Form

Get and Sign Ability Form

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Throat Abdomen Neck G/U Skin Abnormal Respiratory Other Physicians Comments:___________________________________________________________________ OVERALL PHYSICAL EXAMINATION RESULTS: Results Check One PASSED WITHOUT LIMITATIONS: Comments PASSED PENDING THE FOLLOWING: FAILED DUE TO THE FOLLOWING: As of this date, I can find no physical or medical abnormality that would deter this student from fully participating and/or performing patient care activities in the clinical setting...
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