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5. FAMILY HISTORY OF GLAUCOMA 6. Diagnosis A. TYPE Check One Simple Wide Angle Open Closed Angle Narrow Angle. Angle Closure B. DISCOVER -- e.g. routine examination FAA physical examination acute symptoms reduction in visual acuity etc. C. INFORMATION FOR APPLICANT U.S. Department of Transportation Federal Aviation Administration OPHTHALMOLOGICAL EVALUATION FOR GLAUCOMA Privacy Act Statement For Privacy Act Information go to next page. Paperwork .

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