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Get PDF Transitional Work Offer And Acceptance Form - Ohio BWC

A date of injury during the bonus period. Fax the completed form to your managed care organization (MCO). Use the MCO fax number on page two. Employer information Name of company Employer s phone number Name of employee Date of injury Policy number Claim number Job title Transitional work offer On your physician of record/treating physician Date Physician name released you to return to work with restrictions. We offer you the opportunity to participate in our transitional work plan in.

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