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Get DoL CA-20 2014

SICIAN FOR COMPLETING ATTENDING PHYSICIAN'S REPORT 1. COMPLETE THE ENTRIES 1-32 ON THE FORM; AND 2. IF DISABILITY HAS NOT TERMINATED, INDICATE IN ITEM 17; AND 3. SEND THE FORM AND YOUR BILL TO: OFFICE OF WORKERS' COMPENSATION PROGRAMS DOL DFEC Central Mailroom PO Box 8300 London, KY 40742-8300 IMPORTANT: A MEDICAL REPORT IS REOUIRED BY THE OFFICE OF WORKERS' COMPENSATION PROGRAMS BEFORE PAYMENT OF COMPENSATION FOR LOSS OF WAGES OR PERMANENT DISABILITY CAN BE MADE TO THE EMPLOYEE. THIS INFORMAT.

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