Fillable Make sure to enter four digits for the year in all date fields

Description
Vocational Rehabilitation Closure Report Instructions Please print or type. Make sure to enter four digits for the year in all date fields. Follow the distribution on the bottom of the form. Injured worker name (Last) Claim number Total service cost Case resolution (check one) Date of rehab case closure Total living maintenance cost Include narrative. Note: Injured worker's name, claim number and date must be on...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • eFax
  • Email
  • Add Annotation
  • Share
Fill Online
Rate This Form

4.9

Satisfied

54

 Votes