New Hampshire
Workers Comp
Vocational Rehab
Last updated: 4/11/2019
Vocational Rehabilitation Closure {VR5}
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Description
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
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