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PERMANENT DISABILITY RATING, 1997 SCHEDULE: KNEE LIMITATION OF MOTION

Date of birth:
Date of injury:	4/1/1997 to 12/31/2004.
Left knee flexion:	injured: ° uninjured: °
Left knee extension loss:	injured: °
Loss of the left patella?
Right knee flexion:	injured: ° uninjured: °
Right knee extension:	injured: °
Loss of the right patella?
Fraction:
Standard Rating:	%
Occupation by group number:
Or occupation by name:
Occupation description:
Percent industrial (apportionment):	%
Average weekly earnings:	$
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Age for calculation (DOI):
Final formula:
Weekly Comp Rate:	$
Life Pension Weekly Rate:	$
Indemnity:	$
Weeks of Indemnity:
TTD Applies Rate:

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