PRIVACY ACTMATERIAL RE
MOVED
ay
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MEDICAL EVALUATION
This is to certify that I have determined thatEberline
Instrument Corporation employee, _.,
_ 7
-
has no unusual medica} conditions dr physical ‘Impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential
Hemoglobin J¥ Normal
Date 6~ 22-7 /
Z
Af Normal
/7 “,
'
// Abnormal
|
-
tyne MWhsrtMP
Physician's Psnature f
a
piéase type:
Signature Name
Street and No.
City
State
) Zip
Telephone
JAMES J. SHARIPE. FAL D.
4.
1512 TEXAS ST,N, 5.
ALBQIMQUaZ NEW MEXICO &7i1e
PRIVACY ACT MATERIAL REMOVED
.