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Get IL Eye Examination Report

school no later than th October 15 of the year the child is first enrolled or as required by the school for other children. The examination must be completed within one year prior to the child beginning school. Student Name: ___________________________________________ Birth Date: _____________ Sex: _____Grade: _____ (Last) (First) (Middle Initial) (Mo.) (Day) (Yr.) Parent or Guardian: ____________________________________________________ Phone: ________________________ (Last) (First) (Ar.

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