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Jackson County School District
For Staff
Workers Comp Forms
Workers Comp Instructions
Workers Comp Instructions 10.09.23.pdf
183.37 KB
(Last Modified on October 9, 2023)
Comments (-1)
First Report of Injury
first report of injury b-3.pdf
212.53 KB
(Last Modified on December 5, 2022)
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Body Map
Workers Comp Body Map.pdf
171.41 KB
(Last Modified on October 9, 2023)
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Physician of Choice
Workers Comp Physician Choice.pdf
60.49 KB
(Last Modified on October 9, 2023)
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HIPAA Medical Authorization Form
HIPAA Form.pdf
10.05 KB
(Last Modified on October 19, 2021)
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Voluntary Witness Statement
Workers Comp Witness Statement.pdf
6.85 KB
(Last Modified on October 9, 2023)
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Supervisor's Accident Investigation Report
Accident Investigation Form.docx
14.84 KB
(Last Modified on October 16, 2018)
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Billing Authorization Form
Workers Comp Billing Authorization Form.pdf
91.4 KB
(Last Modified on October 9, 2023)
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Drug Testing Form
Workers Comp Drug TestingForm.pdf
167.88 KB
(Last Modified on December 5, 2022)
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Presciption Card
Workers Comp Pharmacy Card.pdf
749.5 KB
(Last Modified on December 5, 2022)
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