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Get UTSA Return to Work Release Form 2020-2024

Name First Name Middle Initial Normal Work Week is Shift Begin Time Division, Department or Office Hours per Day Shift End Time Title / Position Days per Week Before the employee may return to work, the form must be completed by the treating doctor and on file with UTSA Human Resources Leave Administration. PHYSICIAN'S STATEMENT & Physician's Instructions Based on the employee's current medical examination and the job description, please select the box that best describes the employee.

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