WebREG 101 (REV. 3/2007) WWW A Public Service Agency $ VEHICLE INFORMATION REGISTERED OWNER—Print or typewrite true full name(s) as it appears on California … WebC-101-ES: Autorización para divulger información médica : C-108: Waiver of Appeal : C-110: Employer/Employee Agreement to Select Ohio as the State of Exclusive Remedy …
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WebC-101 - Authorization to Release Medical Information: Injured workers should use this form to authorize the release of medical records relative to their work-related injury(s). By signing this form, the injured worker authorizes medical providers who have rendered services relative to the injury to release information to BWC, the Industrial ... WebLiable employers will need to file the report online, if you have 10 or more employee wage items. If you need to file by paper, you may download a blank Employer's Quarterly Tax and Wage Report from our website, or contact the Employer Call Center at 919-707-1150 to request that a blank form be mailed to you. WebIt is strongly encouraged that this form be used to report the accident to the Commission online. It must be completed in its entirety. ... Claims_Employer Report and Injury 101_Master.pdf. Related Forms. Request for Hearing Form: Employer Report of Injury Form: Worker’s and Physician’s Report of Injury Form: pta chairs report