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Get Cigna Leave Solutions Fitness for Duty Certification

Urn to work. Date Prepared: SentDate This section to be completed by the EMPLOYEE: Employee Name: NameFull Employee ID: EmployeeNumber Name of Employer: ClientName Leave Number: ExternalLeaveID Date Leave Began: RequestedStartDate Return To Work Date: I understand that I cannot return to work without a release from my health care provider. Employee's Signature: Date: This section to be completed by the Health Care Provider: I have examined the employee named above and certify that this perso.

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