Form N-648, Medical Certification for Disability Exceptions
License Number Licensing State. E-Mail Address (if any) State or Province. Zip Code or Postal Code Male. Female. A-NOTE: Only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States (including the U.S. territories of Guam, Puerto Rico, and the Virgin Islands) are authorized to certify the form. ................
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