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Click ‘Get Form’ to open the r2 wc in the editor.
Begin by filling out the Identifying Information section. Enter the Board Claim Number, Employee's Last Name, First Name, and Middle Initial. Include the Social Security Number or Board Tracking Number, Date of Injury, and indicate if it is a Catastrophic Injury.
In Section 2, provide the Reason for Report. Attach all necessary documents as specified, such as Initial Rehabilitation Reports or Medical/Therapy Reports.
Complete Section 3 by detailing any Diagnosis & Functional Restrictions and providing a concise summary of activity and recommendations in Section 4.
Fill out Section 5 with your Certificate of Service details, ensuring you include all relevant parties' information.
Finally, review all sections for accuracy before submitting your form through our platform.
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