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Get Rutgers University Accommodation Request: Medical Inquiry Form 2018-2024

TO BE COMPLETED BY THE EMPLOYEE: The employee named below hereby consents and agrees that their treating healthcare provider may complete this medical questionnaire and that the employee s private medical information may be released to the employer, Rutgers, The State University of New Jersey. Your healthcare provider may require that you also sign a HIPAA Authorization form to release certain medical information. You have an obligation to cooperate in the interactive accommodation process, i.

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