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LC 7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12 16 08 Forms

LC 7446 Employee Serious Health Condition Certificate of Health Care ProviderMN12 16 08 Forms

Name: Lc 7446 10 Mn 2019 Form - Fill Out and Sign Printable PDF Template | signNow
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Approximate date condition commenced Probable duration of condition 1 Was the employee admitted for an overnight stay in a hospital hospice or residential medical care facility No Yes If so dates of admission 2 Date s you treated the employee in your office for condition 3 Will the employee need to have treatment visits at least twice per year due to the condition 4 Was medication other than over-the-counter medication prescribed Yes If so state the nature of such treatments and expected...

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