Get
your free Adobe® Acrobat® Reader now!Due to popular demand, the N.C. Industrial Commission has created a Microsoft® Word 2000 document file with form fields for Form 25A—Certification of Material Medical and Vocational Records (G.S. §97-82), effective October 1, 2005 (to be filed with Form 21 or Form 26 for approval of a permanent partial disability rating) (revised 9/05).
| NOTE: You may modify FORM25A.DOC to include the employer's name, address, telephone number, etc., by opening the document in Word 2000, choosing Tools from the Menu Bar, selecting the Unprotect Document option, and filling in the appropriate blanks. Afterwards, you must select Tools, choose Protect Document, click Forms:, click OK, and then save (Ctrl S) the document. |
The Industrial Commission requires that all forms be submitted on white paper and no colored forms will be accepted from this point forward due to the use of an electronic document management system. Paper forms are converted to images and the color is no longer useful but degrades the quality of the electronic image.
You may print and fill out the following PDF (Portable Document Format) version of the Form 25A—Certification of Material Medical and Vocational Records (G.S. §97-82), effective October 1, 2005, and submit it to the commission in lieu of the NCIC's preprinted forms. To view or print this PDF file, you first must download and install a copy of the Adobe® Acrobat® Reader. Click the button below to obtain your FREE copy of Adobe® Acrobat® Reader. (NOTE: Please pay close attention to this software's installation instructions and licensing agreement.)
Get
your free Adobe® Acrobat® Reader now!
Click here to view or download PDF versions of all N.C. Industrial Commission forms.