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Practitioner'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). We are also providing a PDF (WKC-16-B) which you can print and complete by hand.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-16-B-E (English Electronic Version - Word/76 KB)

WKC-16-B (English Print Version - pdf/94 KB)

WKC-16-B-E-S (Spanish Electronic Version - Word/82 KB)

WKC-16-B-S (Spanish Print Version - pdf/168 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.