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1095 c instructions 2019-2024 Form: What You Should Know

Health Examination, Certification and Medical Examination of Employees (PDF), Medical Exam; 2. Medical Exam Documentation Required Employee Report Form. (Division of Workers' Compensation — 8 CCR §9769 (PDF) Employee Form 8.1-2 and all related forms; SF5 (PDF), SF5A (PDF); SF5B (PDF), SF5C (PDF); SF5D (PDF), SF5E (PDF); F1-2 (PDF) — Certification; F2-3 (PDF), F2A-4 (PDF), F2B-5 (PDF) — Medical Examination; SF6 (PDF), SF6A (PDF) — Medical Examination; SF6B (PDF), SF6C (PDF) — Medical Examination. The Medical Examiner shall have copies and a photocopy of the medical records of the following individuals: Medical Examination of Employee (SD CD 8.1202–F5); Medical Examination of Former Employee (SD CD 8.1202–F5); Medical Examination & Certification Application (BJS) (SD CD 8.1202–F5); Medical Examiner Report Form (SD CD 8.1202–F5); Medical Examination of Employee with a History of Mental Illness (SF8); Medical Examination & Certification Application for Employee with a History of mental illness (SF8); Medical Examination Report Form for Worker with a history of mental illness (SF8); Certificate of Occupational Therapy Certification Form (BJS); Certification of Medical Examiner (BJS); Medical Examiner Report Form (SF8); Medical Examination Report (SF8); Occupational Therapy Certification Form (BJS); Certification of Medical Examiner (BJS); Medical Examiner Report Form for Worker (SF8); Medical Report Form for Worker with a history of mental illness (SF8); Worker Certification Form and Medical Examiner Report. Medical Examiner Report. (Division of Workers' Compensation — 8 CCR §§ 9769.08 to 9769.

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