Get Deu Form 100 2020-2026

Filling out the Deu Form 100 is an essential step for individuals seeking a disability evaluation. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the Deu Form 100 online.

1. Press the ‘Get Form’ button to access the Deu Form 100 and open it for editing.
2. Begin by entering your personal information. Fill in your first name, last name, middle initial, and Social Security Number (SSN) using numbers only. Make sure to leave blank spaces between numbers and words where applicable.
3. Provide your current address, including Street Address 1/PO Box and Street Address 2/PO Box if necessary. Fill out the city, state, and zip code accurately to ensure proper correspondence.
4. Input your date of birth in the format MM/DD/YYYY, followed by your date of injury, also in the format MM/DD/YYYY.
5. Fill in the name of your employer and the nature of their business. This provides context for your injury claim.
6. List any relevant claim numbers associated with your disability on the form for reference.
7. Answer the questions regarding your evaluation, including how your evaluating doctor was selected and the name of the doctor who will conduct the examination.
8. Schedule the examination date and detail your job duties at the time of the injury and the nature of your disability caused by it.
9. Explain how your injury impacts your work. Include any previous disabilities resulting from past injuries or illnesses and provide the date they occurred.
10. Finally, check all your entries for accuracy. Once completed, you can save your changes, download, print, or share the filled-out form as needed.

Complete the Deu Form 100 online today to streamline your evaluation process.