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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-143 (BWC-1270)
for the current year.
Form C-143 (BWC-1270) Disability Evaluator Panel (DEP) Physician's Report of Work Ability Physical Conditions - Ohio
What Is Form C-143 (BWC-1270)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-143 (BWC-1270)?
A: Form C-143 (BWC-1270) is the Disability Evaluator Panel (DEP) Physician's Report of Work Ability Physical Conditions in Ohio.
Q: What is the purpose of Form C-143 (BWC-1270)?
A: The purpose of Form C-143 (BWC-1270) is to report a physician's assessment of a person's work ability and physical conditions for disability evaluation.
Q: Who uses Form C-143 (BWC-1270)?
A: Form C-143 (BWC-1270) is used by physicians participating in the Disability Evaluator Panel (DEP) program in Ohio.
Q: What information is required on Form C-143 (BWC-1270)?
A: Form C-143 (BWC-1270) requires information such as the patient's personal and medical history, physical examination findings, clinical impressions, and work ability assessment.
Form Details:
- Released on May 9, 2016;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form C-143 (BWC-1270) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
