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review process. The information on this form is solely used for medical and administrative purposes. No one other than the reviewing physician and staff will have access to the medical form and information without the examinee’s written authorization. AID 1420-62 (12/96) Page 1 "M:\Projects\Project Mngmt\PM Toolkit\ALL\Medical-Physical Exam Report for Long Term Staff.pdf" CHECK EACH ITEM “YES” OR “NO”, EACH ITEM CHECKED “YES” MUST BE FULLY EXPLAINED IN BLANK SPACE ON RIGHT YES.

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