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Gov/getdoc/aa430943-6c80-4480-b44d-a2c96f8c0482/Med-Manual-Adopted-0810-15. aspx Signature of Qualified Medical Professional Medical License Date Name and Address of Qualified Medical Professional Please Type Page 2 Tuberculosis Risk Questionnaire Were you born outside the USA in one of the following parts of the world Africa Asia Central America South America or Eastern Europe Have you ever done one of the following used crack cocaine injected illegal drugs worked or resided in jail or...
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