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Firefighters and Police Officers Medical History Form To the Firefighter or Police Officer: Please complete this form prior to your examination and present the completed form to the medical examiner. If the same examiner
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Document Date: 2014-06-27 17:58:08


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IndustryTerm

beverage / /

MedicalCondition

shortness of breath / high blood pressure / bronchitis / Gout / eczema / Stroke / Heart attack / skin rash / Diabetes / coughing / NO NO Allergies / hayfever / asthma / /

Organization

Birth Address Organization / /

Position

Police Officer / Personal Physician / /

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