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Get VA 10-10M 1992-2024

SE 6. PHONE NUMBER WHEELCHAIR 8E. RESPIRATION ( ) 8F. B/P 7. HOMELESS YES NO 8G. DUE TO INJURY NO YES 9. CURRENT MEDICATIONS 10. TRIAGE 11. SIGNATURE 12. HISTORY AND PHYSICAL 13. DIAGNOSTIC IMPRESSIONS 14. PLAN 15A. ATTENDING OF RECORD 15B. EXMINER’S SIGNATURE SECTION II - FOR PATIENT 1. DISPOSITION / CLINIC APPOINTMENT 4. CONDITION IMPROVED SATISFACTORY IMPRINT PATIENT DATA CARD 2. AFTER CARE SHEET GIVEN 3. FOLLOWUP - ACTIVITY - LIMITATIONS YES NO 5. DATE / TIME OF DISCHARGE.

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