Disability Evaluator Panel (DEP) Physician’s Report of Work Ability Cognitive/Psychological Conditions Forms
| Form Name | Disability Evaluator Panel (DEP) Physician’s Report of Work Ability Cognitive/Psychological Conditions |
| Form # | BWC-1270 C-143 PC |
| Form Revision | (Rev. Dec. 14, 2023) |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Ohio |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |