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Louisiana Department of Public Safety Corrections Office of Motor Vehicles CDL PHYSICAL EXAMINATION FORM Meets Department of Transportation Requirements Date of Examination New Certification Re-certification Follow up 1. DRIVER S INFORMATION Driver completes this section* Driver s Name Address Soc* Sec* No* Date of Birth Age Race/Sex Driver s License No* Class State Telephone 2. HEALTH HISTORY Driver completes this section but medical examiner is encouraged to discuss with driver. Yes No Any...
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