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Get ME Form WCB-220 2018-2024

Presentative: You may only use forms adopted by the State of Maine Workers' Compensation Board for the release of protected medical/health care information to an employer or its insurer. The Board s forms may NOT be altered. Abuses may result in penalties. Notice to employee: The employer/insurer contends your health care provider s medical records, regardless of the date of injury, meaning all records relating to the diagnosis, treatment and care, including X-rays, related to the following.

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