Pennsylvania Forms
7 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
DISMEMBERMENT CHART SEC. 306(c) WORKERS’ COMPENSATION ACT AS AMENDED |
LIBC-134F | REV 09-22 | ||
DISMEMBERMENT CHART SEC. 306(c) WORKERS’ COMPENSATION ACT AS AMENDED |
LIBC-134 | REV 09-22 | ||
Impairment Rating Determination Face Sheet |
LIBC-767 | REV 11-18 | ||
WORKERS’ COMPENSATION MEDICAL REPORT FORM |
LIBC-9 | REV 09-22 | ||
NOTICE: MEDICAL TREATMENT FOR YOUR WORK INJURY OR OCCUPATIONAL ILLNESS |
No Form Number | No Form/Rev Date | ||
PETITION FOR PHYSICAL EXAMINATION OR EXPERT INTERVIEW OF EMPLOYEE (SECTION 314) |
LIBC-499 | REV 04-18 | ||
PENNSYLVANIA WC HEARING - INTERESTED PARTY UPDATE REQUEST |
LIBC-113 | REV 07-22 | ||
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