Physician's Report

Physician's Report (8/11) - [ PDF Format ]

Physicians need to send us this report within three business days of the patient’s first visit if the physician suspects the worker may be disabled beyond the day of injury or if the claim is for a hernia, back condition, shoulder or knee strain/sprain, occupational disease, or mental disorder.

This report is also used to submit a progress report if the worker's condition or treatment has changed since last report or if the worker is ready for return to work.

Packaged in pads of 25 forms, maximum 250 forms per order.