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HISTORY PLEASE COMPLETE ALL OF THIS FORM Name(s) of Insurance Social Security # Exam Date Name Address City State Zip Phone Cell Work Email Date of Birth / / Age Height ft inches Weight in lbs. Blood
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What is history - low vision?
History - low vision is a document that provides information about an individual's visual impairment.
Who is required to file history - low vision?
Individuals with low vision are required to file history - low vision.
How to fill out history - low vision?
History - low vision can be filled out by providing details about the individual's visual impairment.
What is the purpose of history - low vision?
The purpose of history - low vision is to document and understand the visual impairment of an individual.
What information must be reported on history - low vision?
Information such as the cause of the visual impairment, current visual acuity, and any previous treatments must be reported on history - low vision.
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