Attending Physician’s Statement - Trent University
Employee fit for return to work: ( Modified hours /duties in compliance with the functional limitations listed in. Section D (see back of page): How long? _____ Reassessment date _____ Complete recovery expected: ( Yes or ( No If no please explain: _____ SECTION C: (to be completed by a licensed medical practitioner) Is the employee under your active care? ( Yes or ( No If no please indicate ... ................
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