Forms: Medical Information Forms
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Use the links below to access Medical Forms currently maintained through the U-M WorkConnections Illness and Injury Assistance Program.
- Authorization to Release Patient Information
https://www.workconnections.umich.edu/patientauthorization.php (online form)
http://www.workconnections.umich.edu/Forms/wcFormPatientAuthorizationRelease2609.pdf (PDF Format)
- Illness or Injury Report Form
https://www.workconnections.umich.edu/illnessorinjury.php (submit online)
http://www.workconnections.umich.edu/Forms/wcFormIllnessInjuryReport2609.pdf (PDF Format)
- Health Care Provider Report Form
http://www.workconnections.umich.edu/Forms/wcFormHealthcareProviderReport2609.pdf (PDF Format)