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Get Physician's Fitness for Duty Release Form 2005-2024

Al functions of their job in a safe manner. Employee Name: __________________________________________________ Social Security Number: ____________________________________________ Employer: ________________________________________________________ After having reviewed the accompanying job description, this employee is released to return to work: CIRCLE ONE: Full Duty: with no restriction on (date) ___________________ OR Transitional Duty: with restrictions listed in the comments section on thi.

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