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Treated the patient or to report continuing services. (To report permanent impairment, use Form C-4.3.) Use this form only if attaching a detailed narrative report. Please answer all questions completely and submit promptly to the Board, the insurance carrier and to the patient's attorney or licensed representative, if he/she has one; if not send a copy to the patient. Failure to do so may delay the payment of necessary treatment, prevent the timely payment of wage loss benefits to the injured w.

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