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Get OH BWC BWC-1101 2009

as much of all three sections of this form as possible to reduce the time necessary in determining the claim. If this form is completed by the injured worker at the first visit to a medical provider, the injured worker may give the FROI to the provider to complete the treatment information section. The provider can then submit the FROI to the MCO. 3 If you do not know your employer's MCO, contact BWC at 1-800-OHIOBWC and follow the prompts, or use the MCO on BWC's Web site at ohiobwc.com. 4.

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