Maine Forms
9 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
REQUEST FOR INDEPENDENT MEDICAL EXAMINATION |
WCB M-2 | (eff. 1/1/13, rev. 10/15/15) | ||
PETITION FOR AWARD OF COMPENSATION - OCCUPATIONAL DISEASE LAW |
WCB-160 | (eff. 1/1/13) | ||
General Release of Medical/Health Care Information |
WCB-220 | (eff 09/04/2023, rev 10/23/2023) | ||
DIAGNOSTIC MEDICAL REPORT |
M-1 | (Effective 09/04/2023) | ||
Employee Expense Form |
WCB-206 | (eff. 10/1/15, rev. 12/42/23) | ||
Limited Release of Medical/Health Care Information Related to Psychological Matters |
WCB-220-A | (eff 09/04/2023, rev 10/23/2023) | ||
Limited Release of Medical/Health Care Information Related to Substance Use Disorder |
WCB-220-B | (eff 09/04/2023, rev 10/23/2023) | ||
Limited Release of Medical/Health Care Information Related to HIV/AIDS and Sexually Transmitted Diseases |
WCB-220-C | (eff 09/04/2023, rev 10/23/2023) | ||
Revocation of Limited Release of Medical/Health Care Information |
WCB-220-R | (eff 09/04/2023, rev 10/23/2023) | ||
Disclaimer: These forms may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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