001 Industrial Accident Claim
– Form Instructions

024 Medical Care Provider

025 Industrial Accident Claim
– Form Instructions

026 Occupational Disease Claim
– Form Instructions

027 Occupational Disease Claim
– Form Instructions

113a Summary of Medical Record – Industrial Accident
(or you may submit actual medical records supporting your claim)

113b Summary of Medical Record – Occupational Exposure
(or you may submit actual medical records supporting your claim)

152 Appointment of Counsel
(optional)

307 Medical Treatment Provider List
Notes on form 307… ipsum dolor etc

308 Authorization to Release Medical Records (10 Years)

308 Authorization to Release Medical Records (15 years)