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Respectfully yours PETERBOROUGH REGIONAL HEALTH CENTRE Occupational Health Safety Wellness Centre Team One Hospital Drive Peterborough Ontario K9J 7C6 705-743-2121 www. Nature of Illness/Injury Disclosure of Diagnosis is not being requested e.g. cardiovascular neurological orthopaedic respiratory etc. Workplace Injury STOP Do not use this form use a WSIB Form 8. This information provided is for the purpose of determining my fitness to work and/or temporary modifications related to my...
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