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(SIGNATURE)NAME, RANK/RATE(NAME, RANK ... - …

(SIGNATURE)NAME, RANK/RATE(NAME, RANK ... - …

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2. DATE:1. MEMBER'S NAME: Based on the information available as a result of screening, approved medical/dental waivers received, and on the capabilities of the Medical/Dental PART II: RECOMMENDATION OF COMMANDING OFFICER (OR OIC) OF MEDICAL TREATMENT FACILITY.

  Name, Rates, Rank, Signature, Rank rate

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