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Get Asam Criteria Cheat Sheet

the address indicated above. 1. Is the worker medically stationary? Yes No If yes, date: If no, estimated medically stationary date: (Provide closing information and complete Form 827.) Are there permanent restrictions? Yes No Unknown Next scheduled appointment date: 2. Worker is released to: full duty without limitations modified duty Date: (Do not complete lines 3 through 11. Sign below.) from (date): through (date): (specify limitations below) through (date): modified hours .

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