D4 261020
Medical examination report Medical assessment Must be filled in by a doctor D4 Yes Yes No No No No No No No No 2 Diabetes mellitus Does the applicant have diabetes mellitus? If No, go to section 3, Cardiac If Yes, please answer all questions below. Is the diabetes managed by: (a) Insulin? If No, go to Ic If Yes, please give date started on insulin. ................
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