Document GmkNen6p6xz9L21NwrrjDyXyV

'| V tfp WEINZIMMER CLINIC 1211 South Gem At min PHYSICAL EXAMINATION Previous Injuries, Operations or Disease* Deformities from Injuries or otherwise VISION Without Glasses Right Eye 20/ Left Eye 20/ REMARKS: Physical,jdfade, A-Jpd____C____ D______ Best ultimate graaGcL-- Defects determining grading: Signed in presence of Medical Examiner Employee Signed. Cmi'Hc Bu*inn Forma CONFIDENTIAL Defects correctable by: /n.j>/sr-c Thrsiiitner Form It CYWI 5-001636