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Get Medical Documentation Deadline Appeals Board Petition - Pdx

Form is required if you are petitioning due to one of the following reasons (check one): Death in the family. State how this person was related to you (i.e.: parent, spouse, sibling, etc.). Provide a copy of the obituary, funeral announcement or death certificate. Disabling illness or injury to student. A licensed health care professional must complete the section below. Disabling illness or injury of immediate family member that required your care. Your family member s licensed.

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