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PD RATING, 1997 SCHEDULE: SHOULDER LIMITATION OF MOTION

Date of birth:
Date of injury:	4/1/1997 to 12/31/2004.
Which shoulder?	major minor both
Shoulder Abduction:	injured: ° uninjured: °
Shoulder Forward Flexion:	injured: ° uninjured: °
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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