Forms library \u00b7 Topic
Workers’ Comp forms
State-issued first reports, work-status updates, and treating-physician reports for workers' compensation claims.
- Forms tracked
- 33
- PDFs hosted
- 8
- Verified
- 23
All Workers’ Comp forms
33 forms tracked across the BlueHive library.
- Workers’ Comp Verified
Physician's Report
Alaska Department of Labor & Workforce Development – Workers' Compensation Division
Physician's Report — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
ICA Form 102 — Worker's and Physician's Report of Injury
Industrial Commission of Arizona (ICA)
Worker's and Physician's Report of Injury (ICA Form 102) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp
Form 3 — Physician's Report
Arkansas Workers' Compensation Commission
Physician's Report (Form 3) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ CompPDF hosted Verified
DWC Form 5021 — Doctor's First Report of Occupational Injury or Illness
California Division of Workers' Compensation (DWC)
Doctor's First Report of Occupational Injury or Illness (DWC Form 5021) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ CompPDF hosted Verified
PR-2 — Primary Treating Physician's Progress Report
California Division of Workers' Compensation (DWC)
Primary Treating Physician's Progress Report (PR-2) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ Comp Verified
WC 164 — Physician's Report of Workers' Compensation Injury
Colorado Division of Workers' Compensation
Physician's Report of Workers' Compensation Injury (WC 164) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp
Form 30C Attachment — Medical Report Form / Physician's Report
Connecticut Workers' Compensation Commission
Medical Report Form / Physician's Report (Form 30C Attachment) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
DFS-F5-DWC-25 — Uniform Medical Treatment/Status Report
Florida Division of Workers' Compensation
Uniform Medical Treatment/Status Report (DFS-F5-DWC-25) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ CompPDF hosted Verified
WC-20a — Medical Report
Georgia State Board of Workers' Compensation
Medical Report (WC-20a) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ Comp
WC-2 — Physician's Report
Hawaii Disability Compensation Division (DCD)
Physician's Report (WC-2) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
State Form 2118 — Physician's Report
Indiana Workers' Compensation Board
Physician's Report (State Form 2118) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp
Form 1010 — Medical Authorization / Treatment Request
Louisiana Office of Workers' Compensation (OWC)
Medical Authorization / Treatment Request (Form 1010) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
M-1 — Diagnostic Medical Report
Maine Workers' Compensation Board
Diagnostic Medical Report (M-1) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
RW01 — Report of Work Ability
Minnesota Department of Labor and Industry – Workers' Compensation Division
Report of Work Ability (RW01) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
MWCC Medical Report
Mississippi Workers' Compensation Commission (MWCC)
MWCC Medical Report — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
WC-9 — Medical Treatment Form
Missouri Division of Workers' Compensation
Medical Treatment Form (WC-9) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
WC-241 — Eye Injuries with Permanent Disability
Missouri Division of Workers' Compensation
Eye Injuries with Permanent Disability (WC-241) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
Medical Status Form
Montana Department of Labor & Industry – Employment Relations Division
Medical Status Form — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
CMS-1500 — Treating Physician Report (via CMS-1500)
Nebraska Workers' Compensation Court
Treating Physician Report (via CMS-1500) (CMS-1500) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
D-39 — Physician/Chiropractic Physician Progress Report – Certification of Disability
Nevada DIR – Workers' Compensation Section
Physician/Chiropractic Physician Progress Report – Certification of Disability (D-39) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
C-4 — Employee's Claim / Report of Initial Treatment
Nevada DIR – Workers' Compensation Section
Employee's Claim / Report of Initial Treatment (C-4) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp
PROPA — Provider's Report of Physical Ability
New Mexico Workers' Compensation Administration (WCA)
Provider's Report of Physical Ability (PROPA) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
C-4 — Doctor's Initial Report of Injury
New York Workers' Compensation Board (WCB)
Doctor's Initial Report of Injury (C-4) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
C-4.2 — Doctor's Progress Report
New York Workers' Compensation Board (WCB)
Doctor's Progress Report (C-4.2) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ CompPDF hosted Verified
C-4.3 — Doctor's Report of MMI / Permanent Impairment
New York Workers' Compensation Board (WCB)
Doctor's Report of MMI / Permanent Impairment (C-4.3) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ CompPDF hosted
Form 25R — Rating at End of Healing Period
North Carolina Industrial Commission
Rating at End of Healing Period (Form 25R) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ CompPDF hosted Verified
MEDCO-14 (BWC-3914) — Physician's Report of Work Ability
Ohio Bureau of Workers' Compensation (BWC)
Physician's Report of Work Ability (MEDCO-14 (BWC-3914)) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
View form - Workers’ Comp
Form 827 — Worker's and Health Care Provider's Report (Physician's Part)
Oregon Workers' Compensation Division (WCD)
Worker's and Health Care Provider's Report (Physician's Part) (Form 827) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp Verified
LIBC-9 — Workers' Compensation Medical Report Form
Pennsylvania Bureau of Workers' Compensation
Workers' Compensation Medical Report Form (LIBC-9) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source - Workers’ Comp
C-42 — Employee's Choice of Physician / Medical Panel
Tennessee Bureau of Workers' Compensation
Employee's Choice of Physician / Medical Panel (C-42) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
View form Official source - Workers’ CompPDF hosted Verified
DWC Form-073 — Work Status Report
Texas Division of Workers' Compensation (DWC)
Work Status Report (DWC Form-073) — state-prescribed clinician report used by the state workers’ comp agency.
View form - Workers’ CompPDF hosted
APF — Activity Prescription Form
Washington State Department of Labor & Industries (L&I)
Activity Prescription Form (APF) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
View form - Workers’ Comp
WKC-16-B — Practitioner's Report (WKC-16-B)
Wisconsin Department of Workforce Development – Worker’s Compensation Division
Practitioner's Report (WKC-16-B) (WKC-16-B) — state-prescribed clinician report used by the state workers’ comp agency.
View form Official source
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