Department of Labor Claim Forms
Department of Labor EEOICPA Claims Forms
- Employee's Claim, Form EE-1
- Survivor Claim, Form EE-2
- Employment History, Form EE-3
- Employment History Affidavit, Form EE-4
- Medical Requirements, Form EE-7
- Claim for Medical Reimbursement, OWCP-915
How can I get my medical records?
Although the BAECP, Ames Lab-FWP’s office is at The University of Iowa, our project does not automatically have access to your medical records at The University of Iowa Hospitals and Clinics. You must request a copy of your medical records and forward copies to us. Please retain a copy of your records.
The Request to obtain medical record forms are provided below.
Use the UIHC Form to request your records from The University of Iowa Hospitals and Clinics.
Use the VA Hospital Form to request your records from the Veterans Administration Medical Center in Iowa City.
Use the General Form to request your medical records from another hospital or doctor.