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WCC PDF Forms

Form NameForm Number
Arbitration Submittal FormWCAB-32
Arbitration Submittal OrdersWCAB-33
Arbitrator Application (4/2007)
Arbitrator Submittal FormForm 10297
Audit Referral Form (06-2006)DWC-AU-906
Audit Referral Form - Form and Instructions - SPANISH (05-2007)I&A14(sp)
Audit Referral Form - with Instructions (05-2007)I&A 14
Benefit Notice Instruction Manual
Billing and Statement of Charges for Medical-Legal ReportsIMC-76
Case Initiation DocumentRU 101
Choosing Medical Care For Work Related Injuries and IllnessesDW 1194
Complaint About a Workers' Compensation Administrative Law Judge (01-2008)Complaint Form
Cover Page for Medical Provider Network ApplicationDWC 97674
Cover Page for Medical Provider Network Application (05/2007)DWC form 9767.4
Declaration of Readiness to Expedited Hearing - Form with Instructions - SPANISH (05-2007)I&A6(sp)
Declaration of Readiness to Proceed - Form with Instructions - SPANISH (05-2007)I&A5(sp)
Declaration of Readiness to Proceed - with Instructions (05-2007)I&A 5
Declaration of Readiness to Proceed to Expedited Hearing (Trial) - with Instructions (05-2007)I&A 6
Declaration Regarding Protection of Mental Health RecordQME Form 121
Declination Of Vocational Rehabilitation Services (1-1-90 - 12-31-93)RU 107
Denial of Vocational Rehabilitation Benefits (RU-500Y)RU-500Y
Description Of Employees Job DutiesRU 91
Doctor's First Report Of Occupational Injury Or Illness5021
DWC SB 899 NoticeDWC SB 899 Notice
EDEX client acknowledgment of legal constraints on access to information and use of information (06-2006)
EDEX client list (06-2006)
EDEX subscriber application (06-2006)
Election for High Cost OutlierDWC 15
Employee's Claim For Workers' Compensation Benefits (07-2004)DWC-1
Employee's Permanent Disability QuestionnaireDEU100

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