Vocational Rehabilitation Closure Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Vocational Rehabilitation Closure Form. This is a New Hampshire form and can be use in Vocational Rehab Workers Comp.
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Tags: Vocational Rehabilitation Closure, New Hampshire Workers Comp, Vocational Rehab
DATE:TO:VocationalRehabilitationCoordinatorNHDepartmentofLaborVOCATIONALREHABILITATIONCLOSUREFORMEMPLOYEEDATEOFINJURYSOCIALSECURITYNUMBEREMPLOYEROFINJURYREHABILITATIONSPECIALISTREFERRALDATECLOSUREDATEREASONFORCLOSURE(Checkone):RWS:ReturntoworkwithrehabilitationservicesprovidedRWN:ReturntoworkwithNOrehabilitationservicesprovidedNRP:NorehabilitationpotentialLSS:LumpsumsettlementLDH:LaborDepartmenthearingdecisionBCR:BycarrierrequestMMO:MedicalmanagementonlyOOO:Other(Relocation,refusalofservices,death,etc.)12/28/2018VR5 American LegalNet, Inc. www.FormsWorkFlow.com