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City Washington / Boston / / / IndustryTerm metal / health care services / chemical / healthcare providers / e.g. electronics manufacturing / / MedicalCondition CARPAL TUNNEL SYNDROME / Work-related asthma / injury / Asbestosis / diseases / disease / Silicosis / Beryllium disease / poisoning / Chemical pneumonitis / Dermatitis / pleural disease / illness / traumatic injury / Pneumonitis / Work-related carpal tunnel syndrome / exposure/injury / injuries / interstitial lung disease / fibrosis / asthma / / Organization Occupational Health Surveillance Program Massachusetts Department of Public Health CONFIDENTIAL REPORT OF OCCUPATIONAL DISEASE AND INJURY INSTRUCTIONS / / / Position physician / mo. Reporting Physician / / ProvinceOrState Massachusetts / / SocialTag 
Microsoft Word - confidential_report_form