Resources
Sample Templates & Forms
Activity/Prescription Form
Provide this form to an employee’s healthcare provider for information related to an employee’s injury and ability work and any necessary restrictions.
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5173 Waring Road, Suite 134
San Diego, CA 92120
San Diego, CA 92120
info@dmec.org
800.789.3632, ext. 101
800.789.3632, ext. 101
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