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Get PA CD 322 2012

Nation THIS SECTION TO BE COMPLETED BY EMPLOYER This physical examination is for the purpose of employment in a child care facility. The types of activities this individual will be doing are as follows (please check all that apply): Lifting, carrying children Close interaction with children Food preparation Desk work Driver of vehicle(s) Facility maintenance Other – describe below: THIS SECTION TO BE COMPLETED BY PHYSICIAN, PHYSICIAN’S ASSISTANT OR CERTIFIED REGISTERED NURSE PRACTITIONE.

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