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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Normal 2&Normal 2 9Noteb Note   :OutputwOutput  ???%????????? ???;$Percent <Title,Title I} =TotalMTotal %OO> Warning Text? Warning Text %XTableStyleMedium2PivotStyleLight16`RC CSC Form. 211?gfnfX8@z@ 3 A@@  S%%MEDICAL CERTIFICATEI N S T R U C T I O N SADDRESSAGESEX CIVIL STATUSAGENCY / ADDRESSPROPOSED POSITION.OTHER INFORMATION ABOUT THE PROPOSED APPOINTEEOFFICIAL DESIGNATIONBLOODStripped DATE EXAMINEDTYPE LICENSE NO. Urinalysis Chest X-Ray Blood Test Drug TestPsychological Test-Neuro-Psychiatric Examination (if applicable)must be attached to this form:Nb. Attach this certificate to original appointment, transfer and reemployment.3F O R T H E P R O P O S E D A P P O I N T E E HEIGHT (M) WEIGHT (KG)MF O R T H E L I C E N S E D G O V E R N M E N T P H Y S I C I A N>SIGNATURE over PRINTED NAME OF LICENSED GOVERNMENT PHYSICIAN: Bare Foot(For Employment)CS Form No. 211 I hereby certify that I have reviewed and evaluated the attached examination results, personally examined the above named individual and found him/her to be physically and medically FIT / UNFIT for employment.Va. This medical certificate should be accomplished by a licensed government physician.5AGENCY/Affiliation of Licensed Government Physician: ENAME (Last Name, First Name, Name Extension (if any) and Middle Name)Mc. 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