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DBVI7004 Rev 06/10/14DEPARTMENT FOR THE BLIND AND VISION IMPAIRED Health Checklist/General Medical Examination SECTION I:Health Checklist (completed by counselor) Send Report To:Name: Address: D.O.B.:
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The department for form blind is a form used to report financial information related to blindness or visual impairment.
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The purpose of the department for form blind is to track and report financial information related to activities specifically aimed at addressing blindness or visual impairment.
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