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Get DE Report Of Visual Status By An Optometrist Or Ophthalmologist

B. D.L.# ADDRESS DATE DIVISION LOCATION VISUAL ACUITY NO R/ WITH R/ IS THERE ANY EVIDENCE OF EYE DISEASE OR DEFECTOF STRUCTURE THAT WOULD AFFECT VISUAL PERFORMANCE NOW OR IN THE FUTURE? R.E. 20/ 20/ CONTACT LENS L.E. 20/.

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