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Get and Sign Allied Health Recovery Request  Form

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Assessment Diagnosis Have you liaised with the treating medical practitioner? Yes No Is your diagnosis consistent with the medical practitioner’s diagnosis of the compensable injury? Yes Unknown No (if no, please provide details in the last box in section 2) Clinical assessment continued over… Page 1 of 5 Client name Claim number AHRR number Current signs and symptoms --- include reported/observed and relevant objective measures Details of any pre-existing factor(s) directly...
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