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: Lynn Weinberger
WKC-16-B-E (Electronic Version - Word/72 KB)
WKC-16-B (Print Version - pdf/133 KB)
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