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Right Eye 20/ 20/ Right Eye Left Eye 20/ 20/ Left Eye Both Eyes 20/ 20/ HORIZONTAL FIELD OF VISION Applicant can recognize and distinguish among traffic control sign als and devices showing standard red, green, and amber colors ? Yes No Applicant meets visual acuity requirement only when wearing: Corrective Lenses Monocular Vision: Yes No Complete next line only if vision testing is done by an opthalmologist or optometrist Date of Examination 4. HEARING Name of Ophthalmologis.

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