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
MK Certified, LLC
Dr. Mitchell Kohl
1715 Indian Wood Circle
Suite 200
Maumee, Ohio 43537
tel: 402-618-9808
fax: 314-293-6815



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 for an visit via a telemedicine consultation.

It is my recommendation that
.




may return to work on
.

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

Result - Copy and paste this output:

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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