Medical Treatment Statement
Document Number: WKC-3-E
Description: This form must be completed before a prehearing conference (if one is scheduled) and updated before a formal hearing. The form must be brought to both the conference and hearing.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer if you have Microsoft Word. If you do not have Microsoft Word, we are providing a PDF (WKC-3) which you can print and complete by hand.
Content Contact: Lynn Weinberger
WKC-3-E (Electronic Version - Word/95 KB)
WKC-3 (Print Version - pdf/177 KB)
*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.
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