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Get Medical Consent Form To Return To Work

: 1. Following review of the position description, I certify that in my medical opinion, this patient is unable to work from (begin date) to (end date) 2. For Workers Compensation Leaves Only a. May return to alternate duty on (begin date) to (end date) If patient can return to alternate duty, you must complete the NYS Estimated Physical Capabilities Form. b. Will it be necessary for the employee to work less than a full schedule or work intermittently: No.

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