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Get MN Report of Work Ability 2008-2024

a chiropractor, a podiatrist or a dentist. 1. PATIENT INFORMATION: Patient information is to be completed by the medical secretary or nurse, in conjunction with the injured / ill employee or with the employer / supervisor. Complete all requested information. In particular, be sure to complete information identifying the patient and injury: patient name and social security number, date of injury / illness, and employer. 2. AUTHORIZATION TO RELEASE INFORMATION Obtain the patient’s signature a.

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