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CLASS D AND M VISION SCREENING CERTIFICATE This form may only be used by applicants for class D or M learner’s permits or licenses. This form must be completed by an ophthalmologist or by an optometrist who is licensed
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Document Date: 2010-11-03 14:14:30


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File Size: 35,74 KB

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Commonwealth Day / /

IndustryTerm

carrier lens / /

Person

VISUAL ACUITY (Snellen) / /

Position

optometrist / /

ProvinceOrState

Massachusetts / /

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