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Get OH C-84 2019-2024

U must complete the entire form and sign it. It is your responsibility to secure supporting medical documentation from your treating provider for the requested period of disability using the MEDCO-14 form or equivalent documentation. You must complete this form every time you make a request for an initial period of temporary total compensation or an extension of an existing period of temporary total compensation. Instructions Section 1 Injured worker demographics: BWC will use the address pro.

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