Fill out this form as best as you can. An example is located on page 13.The stakes are high, so we recommend that you not write this letter, but instead work with a law firm to draft the letter and provide supporting documentation. This is to certify that the aforementioned employee has fully recovered from the following work injury: which occurred on the date shown above. With Hurts recently coming out of concussion protocol, do you think the Eagles still plan to use the "Tush Push"? An MCO is a health plan with a group of doctors and other providers working together to give you health services. Be sure to include the personal representative's name, address, and telephone number in the letter so the Medical Assistance Estate. Recovery staff can respond. " What to do after one's ID is stolen. Mayo Clinic is a top-ranked hospital in the U.S., with campuses in Arizona, Florida, and Minnesota.