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Get Ut Form 123 2019-2024

Rier with bill and progress reports; 3) copy of form only sent to injured employee, employee s employer, and Utah Labor Commission. PHYSICIAN This report must be filled pursuant to rule R612-100-3 (A), Utah Administrative Code. For your protection Utah law requires notification that any workers compensation fraudulent claim for disability compensation on medical benefits is a crime and may be subject to fines and prison confinement. 1. Physician Name 2. Physician Phone Number 3. Treatme.

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