a.
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OS
408051
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ome
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MEDICAL EVALUATION
This is to certify that I have determined that Eberline
Instrument Corporation employee,
ook
a
ms
has no unusual medical conditions or physical impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential
Hemoglobin /X Normal
AX Normal
// Abnormal
/7 Abnormat
/
Lou!s H. ZUCA
L, M.D. P.C,
5 Signatur
es Bisa Street
sorts pe te
Mes 87504
"th
Please type:
Louis H. Zucal,MD P.C.
Signature Name. 1300 Taisa St
Street and No.
Santa Fe, New Mexico 87501
City
State |
Zip
SOS
telephone
283 4O4G
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