View ESA-OWCP-DLHWC's Form 1215-0031 Online
Agency: |
ESA-OWCP-DLHWC |
Title: |
DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision |
Form Description: |
DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision: In vision injuries, the treating physician uses this form to report their findings and diagnosis. |
OMB Control Number: |
1215-0031 |
OMB Expiration Date: |
Friday, December 31, 2010
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