SECTION XI HEALTH CERTIFICATE
To be completed by examining physician or physician assistant currently licensed pursuant to Chapter 458,
Chapter 459, or any similar law of another state or authorized to act as a licensed physician by a federal agency
or department or by an advanced registered nurse practitioner currently licensed pursuant to Chapter 464.
knowledge, would preclude this person from performing duties in an armed capacity.
Applicant’s (Patient’s) Name:
City: State: Zip Code: