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Failure to provide it may result in an information processing delay. Personal information you provide may be used for secondary purposes Privacy Law s. 15. 04 1 m Wisconsin Statutes. 1. WC Claim Number Employee Name Employee Social Security Number Employee Address 3. Date of Traumatic Event 4. Describe the accidental event or work exposure to which the patient attributes his/her condition* A copy of medical history or notes containing this information will suffice if complete. 5. Give a complet ...

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