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I.U.O.E. Local 4 Health & Welfare Fund P.O. Box 660 Midway, MA 02053 1-888-486-3524 SECTION A LOSS OF TIME CLAIM FORM To be completed by employee Name and home address of employee (please print) (Last
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Local 4 health and is a form used to report health-related information to the local health department.
All individuals and businesses in the local area are required to file local 4 health and.
Local 4 health and can be filled out online or in person at the local health department.
The purpose of local 4 health and is to track and monitor health trends in the local area for public health purposes.
Information such as demographics, medical history, recent travel, and symptoms must be reported on local 4 health and.
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