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Get Tx Fitness For Duty Certification - Dallas County 2015-2024

Certification DATE: EMPLOYEE NAME: PROVIDER NAME: SPECIALTY: PROVIDER EMAIL: Family and Medical Leave for your own serious health condition ends on . Prior to returning to work you must provide a Fitness for Duty Certification verifying whether you are able to return to work, if you have any job-related restrictions and the duration of any restrictions. Please take this Fitness for Duty Certification to your healthcare provider for completion. The agency will use this Fitness for D.

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