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Get and Sign Ability Form
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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