|Classification / Identification:|
| ||Form Number:||014-4474E-67||Edition date: ||2019/12 |
| ||Title:||Prior Testing Disclosure - Powered Mobility Devices|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Assistive Devices|| || |
| ||Program:||Assistive Devices|| || |
| ||Purpose of Form:||This form is used by Manufacturers to report testing of Powered Mobility Devices|| || |
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