This government document is issued by Maryland National Guard for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:zltrvnzn7hc&q=http://freestatemil.maryland.gov/wp-content/uploads/sites/24/2016/02/Med-doc-for-website.pdf&sa=U&ved=2ahUKEwjAzqKl6InxAhWoNOwKHT9eCjs4PBAWMAB6BAgGEAE&usg=AOvVaw2UfClfZpcYPgPVkZtzQSUZ