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Md Disability Pass Form
Name
Specialty:
□
temporary -- anticipated to last until
Signature – licensed health care provider
□ physician □ chiropractor □ optometrist □ podiatrist □ nurse practitioner
Address:
Telephone:
Email:
Medical license #
Issuing state
OFFICE USE ONLY
Approval date:
By:
Exp date
Instructions for Universal Disability Pass
STEP 1
Register with the Department at https://compass.dnr.maryland.gov/DnrCompassPortal
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