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Maryland Universal Disability Pass  Form

Maryland Universal Disability Pass Form

Use a Maryland Universal Disability Pass 0 template to make your document workflow more streamlined.

Limits one or more major life activities. Condition is □ permanent □ temporary -- anticipated to last until Printed name Specialty: Signature – licensed health care provider □ physician □ chiropractor □ optometrist □ podiatrist □ nurse practitioner Address: Telephone: Medical license # Email: Issuing State Exp date OFFICE USE ONLY Approval date: MD Department of Natural Resources Licensing & Registration Service By: May 2017 Instructions for the UNIVERSAL DISABILITY PASS...
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