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Disorder Stomach/Intestinal Genetic Disorder Hearing Impaired Migraine Headaches Musculoskeletal Disorders Prosthesis Seizure Disorder Skin Disease Spina Bifida Urinary/Kidney Disease Visually Impaired Surgical History/Other Please List Please fully explain any answers checked above include severity and symptoms of any allergies Please list any medication s the student takes on a regular basis affect the student s school experience 504 Plan on file YES NO I authorize school personnel to...
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