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May 8, 2009   
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DOL Form LS-205

View ESA-OWCP-DLHWC's Form LS-205 Online htm
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

 

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