Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment

Doctor''s Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment - (Forms/Publications)
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Description This worksheet is to help the attending physician perform impairment rating on their patients with permanent partial disability of the Dorso-Lumbar or Lumbo-Sacral spine.
Form number F252-006-000
Online only. See document above to download.
Languages English
Valid dates 09-2000
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Treating Injured Workers
Web pages For Medical Providers

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