PRIVACY ACT MATERIAL REMOVED
MEDICAL EVALUATION
This is to certify that I have determined that Eberline
Instrument Corporation emplovee,
—
-
_
€
__.
has no unusual medical conditions or physical impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential IK Normal // Abnormal
Hemoglobin
Date
BE Normal
tle./m7
/7Abnormal -~
_
,
Z
ST gallon
-Phystctan’sSignatur
Please type: |
°°
apt
APPS
SignatureNAR&baum St.
Santa Fe, New Mexico 87501
Street ‘and
,
City
'NGY
State
“dl
Zip
telephone
PRIVACY ACT MATERIAL REMOVED