ne

PRIVACY ACT MATERIAL RE

MOVED

MEDICAL EVALUATION
This is to certify that I have determined that Eberline
-_

Instrument Corporation employee,

has no unusual medical conditions or physica] impairments
that would limit his normal duties of employment.
Base Line Blood Counts:

White Cel] with Differential

Hemoglobin DfNormal
Date

S/inph

MK Normal

// Abnormal

/7Abnormal

hysician's,
Please type:
William J. Mitchell, M. D.

Signature Name

8100 Constitution Pl., N. E.

Street and No.

Albuq., New Mexico

293-1616

PRIVACY

RIAL
ACT MATE

REMOVED

87110

Select target paragraph3