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Web instead, i elect to seek alternative medical care and/or refuse further evaluation, treatment. If the employee’s injury is obvious get medical attention and/or call 911, if necessary. My medical condition has been explained to me by my medical provider. I, hereby acknowledge my refusal of medical treatment and/or observation offered to. Use this form if an employee has a.
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This completed form isform, to bealong completed with the by any employee who refuses medical. The reason for and/or the purpose of the. Web refusal of medical treatment form (mployee’s name (please print) employer’s rep/supervisor’s name: Use this form if an employee has a minor injury and they do not feel that they need medical.
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Web instead, i elect to seek alternative medical care and/or refuse further evaluation, treatment. Web brief narrative description of the incident: If the employee’s injury is obvious get medical attention and/or call 911, if necessary. Web employee refusal of medical treatment form.