Form 3Physician's Report
Issued by Arkansas Workers' Compensation Commission
Physician's Report (Form 3) — state-prescribed clinician report used by the state workers’ comp agency.
Key facts
Clinicians fill out · Submitted to regulator · Employers file
- When it’s used
- Initial treatment of work-related injury; subsequent treatment encounters as prescribed by the Commission. Physician must report any known injury arising out of or in course of employment (ACA §11-9-502).
- Who fills it out
- Treating physician of record. Arkansas allows APRNs and PAs to treat injured workers under their scope of practice. The treating physician of record is responsible for medical management and signing required reports.
- Who signs
- Arkansas allows APRNs and PAs to treat injured workers under their scope of practice. The treating physician of record is responsible for medical management and signing required reports.
- Where it goes
- Physician's Report (Form 3): filed with the Commission upon initial treatment. Employer must file First Report of Injury within 10 days. Medical reports per Commission Rule 099.27 at intervals prescribed by the Commission.
- Electronic submission
- Supported — Arkansas supports EDI filing per Commission Rule 099.35 (Electronic Data Interchange Filings). Claims and medical reports can be filed electronically through approved EDI trading partners.
- Narrative substitution
- Form 3 (Physician's Report) is the prescribed form. Narrative medical reports may supplement but are not a substitute for the required form filing (Commission Rule 099.27).
Sources & citations
Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.
Issuing agency
Arkansas Workers' Comp Commission
Statute
ACA §11-9 (Workers' Comp Law)
Regulation
AWCC Rules (099 series)
Form library
AWCC Forms Page
Attribution. Researched and maintained in collaboration with the wc-hub workers’ compensation reporting project (AR). BlueHive does not modify the underlying government PDF; the file you download is the agency original.
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