Amputation Loss Of Use Diagram {BWC-1326} | Pdf Fpdf Docx | Ohio

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Amputation Loss Of Use Diagram {BWC-1326} | Pdf Fpdf Docx | Ohio

Last updated: 4/4/2024

Amputation Loss Of Use Diagram {BWC-1326}

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Description

BWC-1326 -- AMPUTATION/LOSS OF USE DIAGRAM RIGHT HAND POSTERIOR (DORSAL) VIEW. This form is used by the Bureau of Workers' Compensation in Ohio in the context of documenting and illustrating cases involving amputation or loss of use of the right/left hand. It is used to visually represent the affected area from a posterior (dorsal) perspective, potentially for legal, medical, or insurance purposes. Physicians mark exact point of amputation by a single line, mark ankylosis by circling affected joint. Initial all markings and certify the information they provide is truthful and correct. www.FormsWorkflow.com

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