نموذج لياقة
نموذج لياقة
نموذج لياقة
MSP-95-7' Attachment #1
DATE
COMPANY NAME
(PLEASE PRINT)
e seParatelY' with or
without the use ol eyeglasses or contact lenses'
F*ition and visual fields should be normal'
3- Diplopia is UNACCEPTABLE'
isPeech communication
with or without a hearing aid.
suooeru INCAPACITY
NACCEPTABLE.
- the 5 years'
ih6 in"tuo"s, but is not limited to, a history of seizures atter
mellitus'
vestiUular disorders, heart disease, and diabetes
FITTOWORK?
REMARKS:
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ffi
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