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 10 State Forms found

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AS 20.30.121 FIREFIGHTER'S PRESUMPTION LUNG & HEART PHYSICAL EXAMINATION AND CANCER SCREENING FORM

 Form 07-6177 (09/2012)

AS 23.30.121 FIREFIGHTER'S PRESUMPTION MEDICAL HISTORY & EVALUATION FORM

 Form 07-6176 (09/2012)

WORKERS' COMPENSATION MEDICAL SUMMARY

 Form 07-6103 (Rev 8/2023)

EMPLOYER’S NOTICE OF 45 CONSECUTIVE DAYS OF TIME LOSS FOR INJURIES OCCURRING ON OR AFTER NOVEMBER 7, 2005

 Form 07-6170 (Rev. 02/2015)

RELEASE OF COUNSELING, PSYCHOLOGICAL, PSYCHIATRIC, OR ALCOHOL/DRUG/SUBSTANCE ABUSE TREATMENT RECORDS OR INFORMATION

 No Form Number (revised 06/2003

RELEASE OF MEDICAL INFORMATION

 Form 07-6146 (Rev 05/2011)

SECOND INDEPENDENT MEDICAL EVALUATION (SIME) FORM

 Form 07-6147 (Rev 02/2010)

EMPLOYER’S NOTICE OF 25 CONSECUTIVE DAYS OF TIME LOSS FOR INJURIES OCCURING ON OR AFTER JANUARY 1, 2025

 Form 07-6185 (Rev 01/2025)

EMPLOYER’S NOTICE OF 120 CONSECUTIVE DAYS OF TIME LOSS FOR INJURIES OCCURING ON OR AFTER JANUARY 1, 2025

 Form 07-6186 (Rev 01/2025)

EMPLOYER’S NOTICE TO OPT OUT OF STAY-AT-WORK BENEFITS FOR INJURIES ON OR AFTER JANUARY 1, 2025

 Form 07-6187 (Rev 01/2025)
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