Get Mo Dol Wc-303 2017-2025

The MO DoL WC-303 form is a crucial document for individuals seeking to authorize the disclosure of their workers' compensation records. This guide provides you with clear, step-by-step instructions to ensure that you fill out the form accurately and efficiently online.

Follow the steps to complete the MO DoL WC-303 online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In the first section, enter your name in the space provided to authorize the use or disclosure of your workers' compensation records. Be sure to include the last four digits of your social security number.
3. Specify the individual or organization authorized to make the disclosure, which in this case is the Missouri Department of Labor and Industrial Relations – Division of Workers' Compensation. Include the address provided in the form.
4. In the next section, detail the type of records you are authorizing for disclosure. Carefully review the list provided and strike through any records that you do not wish to disclose.
5. Indicate the time frame for which you are restricting the release of records. Fill in the start and end dates in the designated spaces.
6. Acknowledge any information that may be included in your records that requires special authorization, such as records relating to sexually transmitted diseases or mental health services. Initial appropriately.
7. List the individual or organization that the records may be disclosed to, along with their address and the purpose of the disclosure.
8. Review your rights regarding revocation of this authorization and confirm your understanding. Additionally, indicate the expiration date of the authorization if desired.
9. Finally, provide your signature, printed name, date of birth, and claimant address. If a legal representative is signing, they should also include their relationship to you.
10. After completing all sections, save your changes. You can then download, print, or share your completed form as necessary.

Start completing your documents online to ensure you have the necessary records disclosed properly.