| Name SSN/Claim Number |
Disabled | Benefits Start |
Approved Through |
Anticipated Recovery |
Benefits Paid To Date |
|---|---|---|---|---|---|
| FRANK JONES xxx-00-1111 / 00010001 |
mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | $0.00 |
| Activity: Notes: |
END OF USUAL RECOVERY PERIOD SURGERY: mm/dd/yyyy |
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| JOHN HUGHES xxx-00-2222 / 00020002 |
mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | $0.00 |
| Activity: | CLAIMANT EXPECTS TO RETURN TO WORK | ||||
| LINDA JACKSON xxx-00-3333 / 00030003 |
mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | mm/dd/yyyy | $0.00 |
| Activity: Notes: |
UPDATED MEDICAL NEEDED ADC mm/dd/yyyy C-SECTION |
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