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The application will require you to complete the Other, Ibsformorethan, hoursperday, and Yes field.
In the Comments, SecondaryDisablingDiagnosis, NameofPhysicianpleasetypeorprint, SignaturePhysician, Date, PhysiciansLicenseNo, AreaCodeandPhoneNo, and Iauthorize part, point out the crucial details.
As part of part Date, Witness, Witness, NoticetoClient, Date, and Date, state the rights and obligations.
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