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Name: Chart: Date: Patient Medical History Patient Name:Today's Date:Birth Date:Age:Sex:Occupation:Date of Injury:Is this work related? YesNoRight or Left HandedRLIf so was it reported? YesNoPrimary
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How to fill out is this work related:

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Begin by reviewing the nature of the task or request at hand. Consider whether it directly relates to your current job responsibilities or falls under the scope of your job description.
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This work related refers to tasks or activities that are directly related to one's job or occupation.
Employees or individuals who engage in work-related activities are required to file is this work related.
To fill out is this work related, individuals must accurately document and report any activities or tasks that are directly related to their job or occupation.
The purpose of is this work related is to track and record work-related activities for reporting and compliance purposes.
Information such as the nature of the work, time spent on the activity, and any outcomes or results must be reported on is this work related.
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