Physician's Report on Eye Injuries

Document Number:  WKC-16-A

Description:  To be filed by the insurer or self-insured employer when temporary disability exceeds 3 weeks or permanent disability results.

Comments:  This form is not fill-enabled.  It can be printed and completed by hand.

Content Contact:  Don Martin

Document Attachments:  WKC-16-A (pdf/53 KB)

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Updated April 14, 2009