STATE OF CALIFORNIA WORKERS' COMPENSATION APPEALS BOARD CASE NUMBER(S) APPLICANT ___________________________________ v. MINUTES OF HEARING/ORDER/ORDER AND DECISION ON REQUEST FOR CONTINUANCE/ ORDER TAKING OFF CALENDAR/ NOTICE OF HEARING o BEFORE o AT o TRIAL o MSC o CONF o EXP HEARING o LIEN REQUEST DEFENDANTS DATE OF: HEARING APPEARANCES APPLICANT REPRESENTED BY DEFENDANT REPRESENTED BY OTHERS APPEARING INTERPRETER APPLICANT o PRESENT o NOT PRESENT o ATTORNEY o ATTORNEY o ATTORNEY CERTIFICATION NO. o HEARING REP. o HEARING REP. o HEARING REP. PARTY MAKING REQUEST REQUEST FOR: o CONTINUANCE o JOINT o OTOC o AGREE o APPLICANT o DEFENDANT o TELEPHONE o OTHER REQUEST BY: o LETTER POSITION OF OPPOSING PARTY REASON FOR REQUEST o OPPOSE o UNREACHABLE o UNKNOWN BOARD REASON o INSUFFICIENT TIME o REASSIGNMENT: o WCJ NOT AVAILABLE PENDING o FURTHER DISCOVERY: o APP MED o DEF MED o AME o DEPO o CALENDAR CONFLICT: o APPLICANT o SETTLEMENT PENDING o IMPROPER/INSUFFICIENT NOTICE BY PARTY o IMPROPER DECLARATION OF READINESS/VALID OBJECTION o NON APPEARANCE o APP o DEF o LIEN CLAIMANT o WITNESS o APPLICANT o DEF COUNSEL o UNAVAILABILITY OF WITNESSES o VACATION o ILLNESS o APP o DEFENSE o DEFENSE o L.C. o TO START o REFUSED o RECUSAL o TO FINISH o NOT AVAILABLE o REPORTER o INTERPRETER o NOT AVAILABLE o UEF ISSUES o SERVICE DEFECTIVE o BANKRUPTCY o DEFECTIVE WCAB NOTICE o ARBITRATION OTHER/COMMENTS o DISPUTE RESOLVED BY AGREEMENT o NO ISSUES PENDING o JOINDER o CONSOLIDATION o VENUE o NEW APPLICATION o AUTO REASSIGN o DISQUALIFY REPRESENTATION o APP o DEFENDANT o APPLICANT NOW REPRESENTED o REQUESTS o CHANGE OF CIRCUMSTANCES GOOD CAUSE APPEARING, IT IS ORDERED THAT THE REQUEST FOR DAYS FOR o CONT o OTOC IS o GRANTED o DENIED o C&R o STIPS, OTHERWISE: o OTOC o RESET o C&R/STIPS APPROVED o OTOC o C&R/STIPS SUBMITTED FOR APPROVAL o LIEN STIPS AND ORDER APPROVED o N.O.I. TO ALLOW/DISALLOW ISSUED TIME o SET FOR o MSC o CONF o TRIAL o LIEN TRIAL o CONTD TESTIMONY SET ON AT LOCATION o 1 HR o 2 HRS o 4 HRS o ___ DAY BEFORE JUDGE o SUPPLEMENTAL PAGES ATTACHED DATE _____ PAGES WORKERS' COMPENSATION ADMINISTRATIVE LAW JUDGE NOTICE TO Pursuant to Rule 10500 you are designated to serve this/these document(s) on all parties as shown on the Official Address Record. Served on designated server with a copy of the Official Address Record. Date By o Served on parties and lien claimants present American LegalNet, Inc. www.FormsWorkFlow.com CASE NUMBER(S) CASE TITLE V. SUPPLEMENT TO MINUTES OF HEARING/ORDER/ORDER AND DECISION ON REQUEST FOR CONTINUANCE/ORDER TAKING OFF CALENDAR/NOTICE OF HEARING HEARING DATE _________________ COMMENT/DISCUSSION/MOTION ORDER(S) Served with the Minutes of Hearing. WORKERS' COMPENSATION ADMINISTRATIVE LAW JUDGE American LegalNet, Inc. www.FormsWorkFlow.com