Get Wi Wkc-16 2017-2025

The WI WKC-16 form is a crucial document used to report medical information related to industrial injuries. This guide will provide clear instructions and essential details on how to fill out the form accurately and effectively online.

Follow the steps to complete your WI WKC-16 form online.

1. Click the ‘Get Form’ button to access the WI WKC-16 document and open it for editing.
2. Begin by entering the WC claim number and the employee's name in the designated fields. Make sure to spell the name correctly as it appears on official documents.
3. In the patient section, provide the employee's Social Security number, remembering that this is voluntary, and omitting it may cause delays. Enter the employee's address, the date of the injury, the employer's name, and the insurance company’s details.
4. Under the history section, record the patient's description of their injury. Be as detailed as possible to ensure accurate reporting.
5. In the diagnosis section, describe the medical diagnosis thoroughly. This information will be vital for processing the claim.
6. For permanent disability, provide details about any amputations and describe the permanent elements of disability, such as limitations in motion or pain.
7. Indicate whether the healing period has ended and, if so, provide the type of surgery if applicable. If the healing period has not concluded, specify the minimum expected permanent disability.
8. In the prior disability prognosis section, detail any previous disabilities, the prognosis, and the expected return dates for limited and full-time work. Include any suggested further treatment.
9. Add any additional comments if necessary, sign with the physician or chiropractor’s name, and provide their contact number.
10. Finally, review the entire form for accuracy before saving your changes. You can then download, print, or share the completed form as needed.

Complete your WI WKC-16 form online today for efficient processing of your claim.