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Get CCF 211-R 2006-2021

): Date of Examination: Emergency Contact (Name, address, telephone): Reason for Military Discharge: Height Retired Name of Examining Facility (Complete Address): Weight BFP (if applicable, include body fat worksheet): Medical Name of Examiner: PART II – CLINICAL EVALUATION (Please mark the appropriate column) Normal a. BP 1. Sitting Abnormal Normal h. Rectal examination 2. Standing: b. Pulse i. Hearing c. Neurological j. Psychiatry (specify and personality deviation) d. Aus.

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