Xe
*RIVACY ACT MATERIAL
REMavED
.
MEDICAL EVALUATION
=
*
This is to certify that I have determined that Ehertine
Instrument Corporation employee.
7
_
has no unusual medical conditions or physical impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential //Normal // Abnormal
Hemoglobin iFNormal
f/ Abnormal
+ Mee
Please type:
Effie E. G. Medford
Signature Name
City
#304
sh
Telephone
pRIVACY AG
T MATER!
AL REMOVED
ico
87106
%
State
0
”
ab age
erie
tbeSE
TS
201 Cedar St SE
Street and No.
MD