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Employee: Take this form to your doctor.  162k v. 2 Nov 7, 2016, 11:26 AM Karen Porter
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  28k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  52k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  905k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  460k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  53k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  328k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  65k v. 3 Aug 19, 2016, 12:43 PM Chad Lawton
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  1195k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  167k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  1039k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  57k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  955k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  60k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton
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  228k v. 2 Apr 28, 2016, 1:23 PM Chad Lawton