illinois eye exam form
Vision Examination Report
Your response to the questions on this form will indicate to MVD how this persons vision affects his or her ability to safely perform the functional skills
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State of Illinois Eye Examination Report
The examination must be completed within one year prior to October 15 of the year the child enters an Illinois school. Student Name. Birth Date. (Last). Sex.
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new york state medicaid program vision care manual policy
Sep 1, 2013 eye examination is comprised of, at a minimum, a case history, an internal and external eye examination, objective and subjective vision.
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