View ESA-OWCP-DLHWC's Form 1215-0160 Online
Agency: |
ESA-OWCP-DLHWC |
Title: |
DLHWC (Longshore) LS-204, Attending Physician's Supplementary Report |
Form Description: |
DLHWC (Longshore) LS-204, Attending Physician's Supplementary Report: This form is submitted by the attending (treating) physician to submit supplemental progress reports relating to the injured employee's treatment for a work-related injury or occupational illness. This report is used to assist in determination entitlement to workers' compensation benefits. |
OMB Control Number: |
1215-0160 |
OMB Expiration Date: |
Monday, August 31, 2009
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