KANSAS DEPARTMENT OF LABOR www.dol.ks.gov REHABILITATION VENDOR PROGRESS REPORT K-WC-R 93-3 (9-13) Claimant: _______________________________________________ Social Security number _____________ _______ __ Vendor: ______________________________________________________________ Vendor number: _________ Claimant continues to indicate interest in vocational rehabilitation? Date claimant last seen: _________________________ Travel and wait (T&W) cost to date: $ ____________________ Report on: Vocational Assessment Total cost to date (includes amount from T&W to the left): $ ____________________ Rehabilitation Plan YES NO Date of accident: _______________________________ Date referral received: _________________________________ Report due 30 days from receipt of referral and each additional 30 days until the rehabilitation process is completed. Describe progress and discuss issues to be resolved: Signature: ________________________________________________________ QRP number: _______________ Date: ___________________________ (Attach additional sheets as needed) cc: ____ DIVISION OF WORKERS COMPENSATION 401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 · Phone: (785) 296-4000, ext. 2152 American LegalNet, Inc. www.FormsWorkFlow.com