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Yes No X-rays submitted to the OFA: Yes No Were hips evaluated as: Passed Failed Resubmit in 6 Months If Hips were OFA rated as passed, indicate OFA # (Copy of Certificate req.) If no OFA number was issued, indicate OFA rating: Borderline Mild Moderate Severe Elbows x-rayed: Yes No If passed OFA # (Copy of Certificate req.) If preliminary x-ray was sent to OFA, indicate rating: Age in Months Were Hip x-rays submitted to Pe.

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