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Assistance for Doctors in Completing Final Medical Reports

If an employee had a surgical procedure, it is important to indicate the number and types of procedures, and if related to the spine, the level operated upon (for example, L4-S1, C2-C3, etc.)

If DWD Administrative Code 80.32 sets disability based on loss of motion (for instance, shoulders, wrists, fingers), please give range of motion measurements. It is recommended that a WKC-16 form be completed.

If an employee suffers a finger amputation, include a statement as to whether the amputation involved less than one-third, between one-third and two-thirds, or more than two-thirds of the distal phalanx. If the amputation involved more than two-thirds of the distal phalanx, comparative x-rays will need to be taken so that the exact amount of bone loss may be determined.  And, it should be noted on the report which hand is the employee’s dominant hand.

In cases of vision loss, it must be emphasized that a proper permanent partial disability calculation cannot be done without a thoroughly completed WKC-16-A form.

Additional rules regulating when a final exam for determining vision loss may be conducted as defined in DWD Administrative Code, 80.26

For the purposes of calculating permanent partial disability for occupational deafness, obtain for each ear the average hearing level in decibels at these four frequencies: 500, 1000, 2000, and 3000 Hz.

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