Rehab Services Quarterly Report for Workers' Compensation - Wisconsin 2025

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  1. Click ‘Get Form’ to open the Rehab Services Quarterly Report in our editor.
  2. Begin by entering the Claimant Name and Social Security Number in the designated fields at the top of the form.
  3. Fill in the Provider Name, Address, and Provider Number to ensure accurate identification of services rendered.
  4. In the CURRENT STATUS section, check the appropriate boxes and provide details regarding job search status, retraining duration, and employment status.
  5. Complete the CLOSURE INFORMATION section by detailing job search days, costs incurred during this phase, and any retraining expenses.
  6. Finally, sign and date the form before submitting it to the Worker’s Compensation Division as instructed.

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