Form 07-6103 Workers' Compensation Medical Summary - Alaska

What Is Form 07-6103?

This is a legal form that was released by the Alaska Department of Labor and Workforce Development - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 07-6103?
A: Form 07-6103 is the Workers' Compensation Medical Summary in Alaska.

Q: What is the purpose of Form 07-6103?
A: The purpose of Form 07-6103 is to provide a summary of medical treatment related to a workers' compensation claim in Alaska.

Q: Who needs to fill out Form 07-6103?
A: The attending physician or healthcare provider needs to fill out Form 07-6103.

Q: What information is included in Form 07-6103?
A: Form 07-6103 includes details about the injured worker's diagnosis, treatment, work status, and any ongoing medical needs.

Q: Are there any deadlines to submit Form 07-6103?
A: Yes, Form 07-6103 must be submitted within 30 days of the end of each month in which medical treatment was provided.

Q: What should I do with Form 07-6103 once it's filled out?
A: Once filled out, Form 07-6103 should be submitted to the Alaska Workers' Compensation Division and a copy should be provided to the injured worker and their employer.