Physician's Report on Accident or Industrial Disease in Lieu of Testimony
Document Number: WKC-16-B-E
Description: This form is to be used for litigation.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word).
Content Contact: Kathy Froehlich
WKC-16-B-E (Electronic Version - Word/71 KB)
WKC-16-B (Print Version - pdf/14 KB)
*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.
*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.