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Icate if this is a NEW or an UPDATED resident medical evaluation. APPLICANT INFORMATION: Questions 1 through 6 are self-explanatory. 7. ysician s Signature. A licensed physician must sign and date the resident medical Ph evaluation. It may not be signed by a physician in training (a Medical Doctor in Training MT or an Osteopathic Doctor in Training OT ). 9. hysician License Number. P Assistance number. Enter the physician license number, not the Medical 10. Essential Vital.

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