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:  Kathy Froehlich

Document Attachments:

WKC-3-E (Electronic Version - Word/107 KB)

WKC-3 (Print Version - pdf/66 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.