Document qd1D88QqmBy00EKXVqVpn51ZG

WEINZIMMER CLINIC 1211 South Cicero Avenue PHYSICAL EXAMINATION Company. 0-0 Kri>.tfru Re-employment Employee ] Examination R-examination Name Cl Address S \V Height lip ^3 Previous Injuries, Operations or Diseases DafP Q- - - *cQ Nature V. of Work CiQ , 'AC^rQa ^n J-Ll ., Sex Race -- Weight ^ge C^_-^-^ar`ta* StatiA~~'Avx REMARKS: Physical Grid A____C____________D Best ultimate grade ^ Defects determining grading: Signed in presence of Medical Examiner Employee Signed Gr-Ji'Ke Bunineaa Fn c o n f id en t ial f o r ma t i o n REDACTED Form IS CYWI 4-001376 N14538.01