NOTICE OF WAIVER OF WORKERS’ COMPENSATION BENEFITS FOR SPECIFIC MEDICAL CONDITIONS (Spanish) Forms
| Form Name | NOTICE OF WAIVER OF WORKERS’ COMPENSATION BENEFITS FOR SPECIFIC MEDICAL CONDITIONS (Spanish) |
| Form # | LB-0290s / FORMULARIO COMBINADO I-10, I-11, I-12 |
| Form Revision | (REV 11/15) |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Tennessee |
| Language | Spanish |
| State Description | n/a |
| Claimwire Description | n/a |