Return to work note
MK Certified, LLC Dr. Mitchell Kohl 1715 Indian Wood Circle Suite 200 Maumee, Ohio 43537 tel: 402-618-9808 fax: 314-293-6815 [date name="variable_2" default="10/26/2020"] To whom it may concern: My name is Mitchell Kohl, MD. I am a physician licensed in the states of Nebraska, Ohio, Virginia, South Carolina, and Missouri. I have seen patient [text name="variable_1" default=""] for an visit via a telemedicine consultation. It is my recommendation that [text name="variable_2" default=""] [select name="variable_1" value="be released from work|return to work without restrictions|return to work with specific restrictions"]. [textarea name="variable_1" default="sample text"] [text name="variable_1" default=""] may return to work on [date name="variable_1" default="10/26/2020"]. If you have any questions or concerns, please do not hesitate to reach out to my office for additional information. Respectfully, /s/ Mitchell Kohl, MD NPI 1306368691
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Sandbox Metrics: Structured Data Index 0.43, 7 form elements, 92 boilerplate words, 3 text boxes, 1 text areas, 2 dates, 1 drop downs, 7 total clicks
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