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Physician's Report of Occupational Disease - Connecticut
Physician's Report of Occupational Disease is a legal document that was released by the Connecticut State Department of Public Health - a government authority operating within Connecticut.
FAQ
Q: What is a Physician's Report of Occupational Disease?
A: A Physician's Report of Occupational Disease is a form used in Connecticut to report work-related diseases or injuries.
Q: Who needs to fill out a Physician's Report of Occupational Disease?
A: The form should be filled out by the physician or healthcare provider who diagnosed or treated the occupational disease.
Q: What information is required on the form?
A: The form typically asks for details about the employee's work history, the diagnosis, and the healthcare provider's information.
Q: Why is it important to fill out a Physician's Report of Occupational Disease?
A: Filling out the report helps ensure that the employee receives appropriate compensation and helps establish a record of work-related diseases.
Q: Is there a deadline for submitting the form?
A: Yes, the form should be submitted within three days of diagnosing or treating the occupational disease.
Q: What happens after submitting the form?
A: The Workers' Compensation Commission will review the form and may contact the employer or the employee for additional information.
Form Details:
- Released on October 1, 1995;
- The latest edition currently provided by the Connecticut State Department of Public Health;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Public Health.
