Citgo duty medical form 2026

1. Click ‘Get Form’ to open the CITGO Duty Medical Form in the editor.
2. Begin by filling in your personal details, including your name, personnel number, location, supervisor's name, job title, and supervisor's telephone number. Ensure all information is accurate for proper processing.
3. Next, the healthcare provider must review and complete the section regarding the employee’s essential functions. They will provide a diagnosis if necessary and indicate whether the employee can return to work with or without restrictions.
4. In the Authorization for Disclosure section, fill in your date of birth, phone number, and social security number. Sign and date this section to authorize disclosure of your health information.
5. Finally, ensure that all sections are completed accurately before submitting. Use our platform’s features to save and share the form securely with CITGO Health Services.

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