Below, you will find a preview of the required Medical Examiner Report Form MCSA-5875. This is the standard form used for general certifications. It is required that the patient complete Section 1. After completion, provide the forms and certificate to your employer.
If you are insulin dependent, there is a separate form that is required. This form can be found at the following link:
INSULIN DEPENDENT MCSA-5870 FORM
WE WILL BE CLOSED 04/19/25 IN THE OBSERVANCE OF THE EASTER HOLIDAY!
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