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 available as an electronic Microsoft Word template or an Adobe pdf template that can be filled out on your computer. There is also an Adobe print version if you want to print and complete by hand.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-3-E (Electronic Version - Word/94 KB)

WKC-3-E (Electronic Version - pdf/497 KB)

WKC-3 (Print Version - pdf/15 KB)

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