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Get ME WCB-1 2002

ONE OR MORE DAYS 2b. WAS EMPLOYEE PAID FOR 1/2 DAY OR MORE ON DAY OF INJURY? 3. ■ LOST EARNINGS BUT NO LOST TIME 4. 6a. ■ OCCUPATIONAL DISEASE 6b. DATE OF LAST EXPOSURE: _____/_____/_____ MM DD YYYY 6c. DATE OF DIAGNOSIS AS OCCUPATIONALLY RELATED: _____/_____/_____ MM DD YYYY 7a. ■ CORRECT PRIOR REPORT 7b. DATE OF CORRECTION: _____/_____/_____ MM DD YYYY 7c. DATE CORRECTION SENT TO WCB: _____/_____/_____ MM DD YYYY 8. STATE EMPLOYER UNEMPLOYMENT INSURANCE ACCOUNT NUMBER (UIAN): .

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