PRY VACY ACTT MaM
rAeTpEayR REMOVE
D
MEDICAL EVALUATION
This is to certify that I have determined that Eberline
Instrument Corporation employee,
has no unusual medical conditions or physical impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential MfWorma'
Date 3 el 78
{7 Abnorma}
9 Has v0
mes S Signature
Please type:
Kael
Mooedl MLD.
Signature Name
TTY Emin
Street and No.
olb.
City
Ww
NM
State
WUE.
87173
Zip
SBYS3-TI0l
Telephone
eae a hg
apy |
“ wo MigSpaUS
SS
*
AFNorma)
=
Hemoglobin
// Abnormal
AL REMOVED
PRIVACY ACT MATERI