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Get Va Form 21 2680 Printable Fillable

ACE OF EXAMINATION 6. WAS CLAIMANT ACCOMPANIED TO PLACE OF EXAMINATION? (If "Yes," complete YES NO Items 7 and 8) 9. IS CLAIMANT HOSPITALIZED? YES NO 7. NAME OF NURSE OR ATTENDANT 10. DATE ADMITTED 5. DATE OF EXAMINATION 8. MODE OF TRAVEL 11. NAME AND ADDRESS OF HOSPITAL (If "Yes," complete Items 10 and 11) NOTE: VA MEDICAL EXAMINER PLEASE READ CAREFULLY The purpose of this examination is to record manifestations and findings pertinent to the question of whether the claimant is housebo.

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