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Board Rule 61b22 Form Wc104

Notice To Employee Of Medical Release To Return To Work With Restrictions Or Limitations

For non-catastrophic accidents occurring on or after July 1, 1992, the employer/insurer shall send this form to the employee no later than 60 days after the medical release of the employee to return to work with restrictions or limitations.

  • Form WC-104/Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations

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Seth Bader
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