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Get and Sign Box 44516 Baton Rouge, Louisiana 70804 4516  Form

Get and Sign Box 44516 Baton Rouge, Louisiana 70804 4516 Form

Use a Box 44516 Baton Rouge, Louisiana 70804 4516 template to make your document workflow more streamlined.

Symptoms etc. Social and biographical history Physical examination Vital Signs Height ft. 14-12C Form 12C 8660 United Plaza Blvd. 70809 P. O. Box 44516 Baton Rouge Louisiana 70804-4516 Phone 225. 925. 6484 Toll-free 1. 800. 256. 3718 Fax 225. 922. 1001 www. lsers. net 6/17 Print Physician Report of Disability Reset This form must be completed by the applicant and their physician as part of the process for Disability Retirement Annual Re-Examination or to certify a Surviving Child with a total...
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