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Medical Seat Belt Waiver  Form

Medical Seat Belt Waiver Form

Use a ks medical seat belt exemption form template to make your document workflow more streamlined.

Prevents appropriate restraint in a safety belt and qualifies for a seat belt exemption card. I understand that willful and false certification shall subject me to fines/imprisonment as outlined in R.S. 32:295.1 (D)(9). The reason the use of a restraint is inappropriate is: ____________________________________________________________________ ______________________________________________________________________________________________________________ TEMPORARY DISABILITY. The period of time for...
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