LAND, SEA AND AIR MEDICAL REVIEW SPECIALISTS
Arnold D. Panzer, MD |
Phone: (631) 225-3060 |
Termination List
Date _________________
| Company Name | _______________________________________________________ |
| DER Name | _______________________________________________________ |
| DER Phone # |
_______________________________________________________ |
| Designated Secure Fax | _______________________________________________________ |
| Please list any safety sensitive employees who have been terminated. Please send this list whenever anyone has been terminated. This will help up better update the random list selection for your company or consortium. |
| Please fax this list to Land, Sea and Air Medical
Review Specialists at (631) 581-4075. If you have e-mail capabilities, please e-mail
this list to: lsa@lsamr.com. If you have neither,
then please mail to Land, Sea and Air Medical Review Specialists at the address at the
bottom of this form.
|
| Employees Terminated | Social Security # | Date |
910 Route 109 ° North Lindenhurst, New York 11757