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Blood Pressure TB Test Optional Lead Screening Hct. Positive Vision With Glasses Right Left No Glasses Negative RBC Urinalysis Result COMMENTS by Physician Tonsils and Glands Hearts and Glands Abdomen Congenital Anomalies Signature of Examining Physician Revised 07/2016. To be filled out by Doctor Return at the August Orientation Day PRESCHOOL / KINDERGARTEN HEALTH ASSESSMENT RECORD Child s Name Address Last First Birthdate Middle Parent s or Guardian Home Phone Father Mother Child s...
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