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February 19, 2024

Fitness For Duty Report to Employer

Fitness for Duty Return to Work Report Patient Information: Evaluation Details: Current Condition: Assessment of Fitness for Duty: Restrictions/Accommodations: Further Evaluation Required: Additional Recommendations: Follow-Up Plan: Provider Information: Disclaimer: Please feel free to reach out to our practice if you require any further clarification or information regarding the employee’s fitness

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