Labels:text | screenshot | font | black and white | number | document OCR: ATTACH ORIGINAL OR A PHOTOCOPY OF YOUR LICENSE HERE: SECTION 3 - TO BE COMPLETED BY PHYSICIAN PHYSICIAN'S CERTIFICATION OF DISABILITY Print, type, or stamp physician's name: Please see notice below Street address: City, State, ZIP code: Office telephone number: . 1 I CERTIFY THAT I have read the Notice to Physician Certifying to a Disability, and that the person named in Item 1 on the reverse is severely handicapped, the duration of which will extend for more than 365 days beyond this date, Because of this severe handicap, this person is unable to pass a 13 or 20 words per minute telegraphy examination. I am licensed to practice in the United States or its Territories as a doctor of medicine (M.D.) or doctor of osteopathy (D.O.). I have considered the accommodations that could be made for ...
