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Get Memorial Hermann Work Status Form for Injured Employee

- Return to Work Status (Please Choose One) Employee can return to work to perform the essential function of the position per the job description as of ______________________ (Date) WITHOUT restrictions. Employee can return to work on a temporary transitional duty basis provided the work is consistent with the activity restrictions identified in Section C: __________________ (Date) which are expected to last through ____________________ (Date). Employee is unable to return to work per the job d.

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