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WORKER'S COMPENSATION FORMS FOR THE TREATING PHYSICIAN

FORM 5021
Doctor's First Report of Occupational Injury or Illness

FORM PR-2
Primary Treating Physician's Progress Report

FORM PR-3
Primary Treating Physician's Permanent & Stationary Report

FORM DEU 102
Request for Summary Rating Determination (of Primary Treating Physician's Report)
This form should be attached to Form PR-3.

FORM RU 90
Treating Physician's Report of Disability

FORM RU 91
Description of Job Duties

DWC FORM 280
Petition for Change of Primary Treating Physician

IMC FORM 81556
Treating Physician's Determination of Medical Issues
This is an optional form that can be used by a treating physician as a supplemental report, at the completion of treatment, at discharge, or when a worker becomes permanent and stationary.
 

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