Notice of Occupational Disease or Infection

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Notice of Occupational Disease or Infection

(96 KB PDF)

Used by medical providers to notify L&I that an occupational disease or infection has been diagnosed and that the worker has been advised that their condition may be work-related. This form can be used if the worker does not complete a Report of Accident or Occupational Disease (ROA) but should not be completed in place of an ROA.

Número del formulario F242-243-000
Disponibilidad Online only
Palabras claves claims, diseases, industrial insurance, worker's compensation, workers compensation, workers' compensation
Idiomas English
Fechas válidas 12-2012
Contacto Claims for Job Injuries

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