Deu 100 2026

1. Click ‘Get Form’ to open the deu 100 in the editor.
2. Begin by filling in your personal information. Enter your first name, last name, and Social Security Number (SSN) in the designated fields.
3. Provide your complete address, including street address, city, state, and zip code. Ensure that you leave blank spaces between numbers and words for clarity.
4. Input your date of birth and date of injury using the MM/DD/YYYY format.
5. Fill in your employer's name and nature of their business. If applicable, include multiple claim numbers as needed.
6. Answer the questions regarding your evaluating doctor and provide details about your job duties at the time of injury. Be thorough in describing how the injury affects your work.
7. Finally, sign and date the form before submitting it to ensure all information is complete.

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