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How to use or fill out Printing T: AAOSHARE FINLFORM C3 1 FRP - Workers
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Click ‘Get Form’ to open it in the editor.
Begin by entering the Injured Employee's Name and Social Security Number in the designated fields. This information is crucial for identifying the individual involved.
Next, input the Date of Accident. Ensure this date accurately reflects when the injury occurred, as it is vital for processing claims.
Fill in the Employer's Name and Address. This helps establish the relationship between the employee and employer regarding workers' compensation.
Review the instructions provided for selecting a health care provider. You may choose any authorized physician accepting workers' compensation patients.
Sign and date the form where indicated, ensuring that both the Injured Employee and a Witness provide their signatures.
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Form 110 workers' CompensationC105 1 formC-27 form Workers' CompensationWhat is C3 formFirst aid Workers' CompensationBP-1 formWorkers' Compensation accident formWorkers comp tax form
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C-3
This form allows the health care providers you list below to release health care information about your previous injury/ illness to your employers workers
To the Employer: The employer shall provide the above-named injured employee with a copy of this signed form and shall maintain the original form in the
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