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Physician Letter: Functional Abilities Form

This is a sample cover letter addressed to the medical practitioner that can be included along with the Functional Abilities Form and Employee Informed Consent Form. This letter explains why the Functional Abilities Form must be completed and how the information provided will be used.

Consult the guide for Obtaining Information for Health Care Practitioners in Cases of Employee Illness or Injury for more information on when and how to use this form.