Physician'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).

Content Contact: Lynn Weinberger

Document Attachments:

WKC-16-B-E (Electronic Version - Word/72 KB)

WKC-16-B (Print Version - pdf/133 KB)

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