Archives: ULC Forms

113b Summary of Medical Record – Occupational Exposure

summary of medical record occupational exp 3.10
113b Summary of Medical Record – Occupational Exposure
(or you may submit actual medical records supporting your claim)

026 Occupational Disease Claim

Industrial Accidents Form 025 - Occupational Disease Claim
026 Occupational Disease Claim
– Form Instructions

113a Summary of Medical Record – Industrial Accident

summary of medical record industrial accident 3.10
113a Summary of Medical Record – Industrial Accident
(or you may submit actual medical records supporting your claim)

308 Authorization to Release Medical Records (10 Years)

Form 308 - 15 years
308 Authorization to Release Medical Records (10 Years)

001 Industrial Accident Claim

Industrial Accidents Form 001
001 Industrial Accident Claim
– Form Instructions