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The document is a medical examination report requested by the County Department of Social Services to assess an individual's health status and functional limitations for work or training. It includes sections for personal information, authorization for medical information release, and detailed medical evaluations by a physician regarding the individual's conditions, work capacity, and potential need for vocational rehabilitation.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (133 Votes)
2005	4.3 Satisfied (117 Votes)

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