@asad.ali
overlay.pdf (46.5 KB)
Attached the requested document and below is the content that went on to the document. Please let me know if you need any other information.
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"printLine": "AAAAAAAAAAAA 2021-11-13-14:55:23.228931 "
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"printLine": " AAAAA AAAAAAAA DIVISION OF MOTOR VEHICLES "
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"printLine": " DRIVER LICENSE SECTION "
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"printLine": " CONSENT/INFORMATION FORM "
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"printLine": "TESTT TESTTEST "
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"printLine": "Customer No. 000000000000 "
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"printLine": "Dr. Ed. Rep. No. Dr. Ed. Sch. Bus "
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"printLine": "Driver please complete the following: "
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"printLine": "Date of Birth _________ Race ___ Sex ___ County ________ "
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"printLine": "I hereby authorize Dr./Counselor_____________________________to give any "
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"printLine": "examination they deem necessary for the purpose of determining my physical "
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"printLine": "fitness to operate a motor vehicle. I understand this authorization "
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"printLine": "includes permission for this information to be reviewed by a medical "
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"printLine": "advisor approved by the division for the purpose of a recommendation to be "
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"printLine": "rendered to determine my driving needs and abilities. "
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"printLine": " SIGNATURE OF APPLICANT: _______________________ "
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"printLine": " PARENT/GUARDIAN IF MINOR:______________________ "
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"printLine": "Telephone No.:Home (___)______________Business(___)________________________ "
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"printLine": "Are you ___Retired____ Disabled______Occupation:___________________________ "
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"printLine": "What type of vehicle do you drive? Automobile______School Bus______________ "
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"printLine": "Commercial Motor Vehicle_____Other_________________________________________ "
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"printLine": "Does your job require driving? ____________________________________________ "
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"printLine": "___________________________________________________________________________ "
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"printLine": "To Physician "
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"printLine": "When completing the Medical Report Form, please keep in mind the physical, "
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"printLine": "mental and emotional requirements necessary for the safe operation of a "
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"printLine": "motor vehicle, for the patient and public welfare. Please answer all "
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"printLine": "questions and applicable parts of PP. 2-7, which list thereview of "
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"printLine": "conditions pertinent to driving. If you circle \"Yes\" for any of these "
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"printLine": "conditions, you should address all the questions pertaining on the "
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"printLine": "proceeding pages. You do not need to answer questions on the form for which "
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"printLine": "you circled \"No\". Upon completion of this form please make an overall "
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"printLine": "statement about your patient's medical condition and its potential effect "
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"printLine": "on safe driving. "
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