Get form dfs f2 dwc 1

Description of first report form
B. Full Salary in lieu of comp AWW P. T. DEATH Full Salary End Date / / Comp Rate SETTLEMENT ONLY Interest Amount Paid in 1st Payment REMARKS INSURER NAME INSURER CODE EMPLOYEE S CLASS CODE SERVICE CO/TPA CODE Form DFS-F2-DWC-1 03/2009 Rule 69L-3. FIRST REPORT OF INJURY OR ILLNESS RECEIVED BY CLAIMS-HANDLING ENTITY SENT TO DIVISION DATE DIVISION RECEIVED DATE FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF...
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form dfs f2 dwc 1
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