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Get Ca Universal Urgent Care Occupational Medicine Patient Referral 2019-2025

Employer: Treat Injury / Illness: Drug Screening: If yes: Reason: Yes Yes Physical: If yes, DOI: / / No Rapid screen Pre-Emp Pre-Emp Non-DOT Post Post injury Injury DOT Reasonable Post accidentSuspicion / For Reasonable / For Cause Cause Suspicion Random Random Post accident Other: Breath Alcohol Testing (BAT): Reason: No Post Post injury Injury Ye.

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