DETERMINE THE VALUE OF YOUR SCHEDULE AWARD
Click the boxes that apply
Loss of Use or Diminished Use?
Yes
Loss of Strength or Diminished Strength?
Yes
Loss of Motion or Diminished Motion?
Yes
Loss of Feeling or Diminished Sensitivity?
Yes
Loss of Muscle Tone?
Yes
Loss of Function or Diminished Function?
Yes
Increased Sensitivity?
Yes
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Injured Body Parts:
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