Legal Forms >> Texas >> Workers' Compensation
Form #:TX-WC-0069 This form is used by a doctor to report the status of an injured employee. The form must be signed by either the treating doctor, a doctor selected by the treating doctor, a designated doctor selected by the Division of Workers' Compensation, or a carrier-selected doctor appointed by the Division. General information about the employee, the extent of the injury, the anticipated time of MMI (maximum medical improvement), and whether or not the employee is permanently impaired shall be present on the form.
Name:Report of Medical Evaluation Form Number: TX-WC-0069 State:Texas Statute: Form Category:Workers' Compensation
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