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Get massDOT Form T21893 2014

Its them to a one year medical certificate. If condition #6 is selected on your medical certificate and you do not fall under the grandfather clause, condition #6 was most likely chosen by the medical examiner in error. You should return to the medical examiner to request a revised medical card. Telephone #: Issue Date: Medical Examiner’s Name: Specialty Code: (MD, DO, PA, CH, AN, or Other) License No: Issuing State: Suffix: Medical Examiner’s National Registry No: Medical Certificatio.

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