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

Document Attachments:

WKC-16-B-E (Electronic Version - Word/72 KB)

WKC-16-B (Print Version - pdf/133 KB)

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