Common use of Address Clause in Contracts

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/MidwifePractitioner’s/▇▇▇▇▇▇▇’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/MidwifePractitioner’s/▇▇▇▇▇▇▇’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: _ Will return to work on:

Address. TELEPHONE NUMBER: I, _ confirm that _ (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: _ Will return to work on:: _ (Date)

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’spractitioner’s/Midwife’s nameName) (Please please print employee’s name) was treated by me on , is or was unable to work (Date) due to Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/MidwifePractitioner’s/▇▇▇▇▇▇▇’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/MidwifePractitioner’s/▇▇▇▇▇▇▇’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please print employee’s name) was treated by me on , is or was unable to work (Date) due to PROGNOSIS: Will not return to work: Will return to work on:

Address. TELEPHONE NUMBER: I, confirm that (Physician’s/Nurse Practitioner’s/Midwife’s name) (Please please print employee’s name) was treated by me on , is or was unable to work (Date) due to (Nature of illness/injury only) Will not return to work: Will return to work on: