Get Mo Dol Wc-303 2017

Filling out the MO DoL WC-303 form can seem daunting; however, this guide will provide you with clear, step-by-step instructions to assist you in completing it correctly. This form is essential for authorizing the disclosure of your workers' compensation records.

Follow the steps to effectively fill out the form online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. In the first section, input your full name in the specified field. This must include your first, middle, and last names.
3. Enter the last four digits of your social security number in the designated area. Ensure that you keep your full social security number confidential.
4. In the next section, confirm the organization authorized to make the disclosure by verifying the details of the Missouri Department of Labor and Industrial Relations – Division of Workers' Compensation.
5. Review the list of records being authorized for disclosure. Strike through any records that you do not wish to disclose. Ensure that all relevant records are included.
6. Indicate the period during which the records should be released by filling in the start and end dates.
7. Acknowledge your understanding by initialing next to the relevant sections regarding sensitive information such as sexually transmitted disease information and behavioral health services.
8. Designate the individual or organization to whom the records may be disclosed, including their address and the purpose for the disclosure.
9. Review the authorization expiration date, event, or condition. If you do not specify, it will automatically expire in one year from the date of signing.
10. Your signature, printed name, and date of birth must be entered in the appropriate fields. If you are signing as a legal representative, provide your relationship to the claimant.
11. Lastly, consider having the form notarized. The notary section must be filled out, including date and notary public signature.
12. After reviewing all entries for accuracy, you can save your changes, download, print, or share the completed form.

Take the next step in managing your workers' compensation records by filling out the MO DoL WC-303 online today.