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Jury City State Current employer Nine-digit ZIP code Job title Employer address City Receives a gross weekly salary of State Works Nine-digit ZIP code Hours per week Conditions regarding the receipt of Living Maintenance Wage Loss (LMWL) I must have a release from the physician of record (POR) to return to work with restrictions at the initial authorization for LMWL. To continue to receive LMWL, I must also submit restrictions from the POR every six.

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