Form I-693, Report of Medical Examination and Vaccination ...
Form I-693 07/15/19. Page 1 of 14. ... City or Town State. ZIP Code Gender. Male. Female ... (Health departments and military treatment facilities MUST place their official stamp or seal here) (official stamp or seal here) I have not had my license to practice medicine revoked, and I am not subject to any restrictions on any license to practice ... ................
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