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Get Medical Condition Request Form

Ich prevents or limits the client s participation in WorkFirst activities that could include job search, job preparation, education classes, training, or working. Please complete the enclosed form to describe these limitations. In addition, if a condition is expected to last longer than three months, please also provide copies of current chart notes. We will use this information to determine the level of participation up to 40 hours per week, in job search, job preparation, educational classes.

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