Form Pr-3 - Primary Treating Physician'S Permanent And Stationary Report Page 7

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STATE OF CALIFORNIA
Division of Workers’ Compensation
PRIMARY TREATING PHYSICIAN’S PERMANENT AND STATIONARY REPORT (PR-3)
List information you reviewed in preparing this report, or relied upon for the formulation of your medical opinions:
Medical Records:
Written Job Description:
Other:
DWC Form PR-3 (Rev. 01/01/05)
7

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