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II. Specify any abnormality use reverse of form if needed R L Vision - with glasses/contact lenses Vision - Near Point Hearing Pass 20 db sc both ears or IV. V. Scoliosis Negative Positive PHYSICAL EDUCATION / SPORTS / PLAYGROUND / WORK QUALIFICATION / CSE CONSIDERATION Free from contagions physically qualified for all physical education sports playground work school activities Limited Participation Specify Specify medical accommodations needed for school None OPTIONAL INFORMATION if...
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