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Urgent Injury ClinicWORKERS COMPENSATION FORM RETURN TO FAX (515)2216566 EMAIL workcomp@dmos.comFirst nameLast nameTodays dateDate of birthAddressCity, State, ZipDate of incidentDiagnosisDescription
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01
Gather all necessary information and documents needed to fill out the workers compensation form.
02
Begin by entering your personal information such as name, address, and contact details.
03
Provide details about your injury or illness and how it occurred while on the job.
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Include any medical treatment you have received for the injury or illness.
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Sign and date the workers compensation form before submitting it to DMOS Orthopaedic Centers.

Who needs workers compensationdmos orthopaedic centers?

01
Individuals who have sustained work-related injuries or illnesses that require orthopaedic treatment.
02
Employers who are required to provide workers compensation benefits to their employees.
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Workers compensation at DMOS Orthopaedic Centers is a system that provides medical benefits and wage loss compensation to employees who are injured on the job while treating their orthopaedic conditions.
Any employee who has sustained a work-related injury or illness at DMOS Orthopaedic Centers is required to file for workers compensation.
To fill out the workers compensation form at DMOS Orthopaedic Centers, obtain the necessary documentation from HR, complete the employee injury report, provide medical treatment details, and submit the form as per the center’s guidelines.
The purpose of workers compensation at DMOS Orthopaedic Centers is to ensure that injured employees receive appropriate medical care and financial support during their recovery process.
The information that must be reported includes the employee's personal details, incident description, medical treatment received, and any lost wages due to the injury.
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