Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
 Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment (833 KB PDF)
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| Description | This worksheet is to help the attending physician perform impairment rating on their patients with permanent partial disability of the Dorso-Lumbar or Lumbo-Sacral spine. | |
| Detail | ||
| Form number | F252-006-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | dorso-lumbar, lumbo-sacral | |
| Languages | English | |
| Valid dates | 09-2000 | |
| Contact information |
Managing Injured Workers' Claims
Claims for Job Injuries Treating Injured Workers |
|
| Web pages | For Medical Providers | |
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