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Get NJ WFNJ-MED-1 2015

Ment? Yes ☐ No ☐ Do any of the above diagnoses limit the patient’s ability to participate in gainful employment and/or occupational training? Yes ☐ No ☐ If yes, please specifically explain how the diagnoses limits the patient’s ability to participate in gainful employment and/or occupational training (ex. unable to stand for long periods of time, unable to lift objects, etc.): Is the patient able to engage in any gainful employment and/or occupational training of any kind? Yes ☐ N.

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