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WORKERS’ COMPENSATION FORM GUIDE

State workflows are highly variable.

An occupational injury clinic can need a state report, a clinical narrative, an employer work-status form, and an insurer-specific request—all for the same case. InjuryMgmt makes it easier to onboard that mix of custom and state-specific forms into one digital documentation workflow.

Talk through your forms

ONE CASE. SEVERAL DOCUMENT MOMENTS.

The form changes.
The clinical story continues.

01 / 04

First report

How the initial injury or first treatment is documented.

02 / 04

Visit & work status

What records the exam, restrictions, and return-to-work plan.

03 / 04

Treatment requests

What a proposed service needs before it can proceed.

04 / 04

MMI & impairment

What closes the clinical story when a rating is applicable.

These are common documentation moments, not a required sequence for every claim.

FOURTEEN STARTING POINTS

Workers’ comp forms,
state by state.

Different combinations of statutory forms, visit notes, work-capacity reports, and payer requests shape the day-to-day workflow. Here are 14 examples.

02 / 14

Florida

One recurring state report

The DWC-25 carries treatment and status information across visits, while insurer authorization remains a separate question.

DFS-F5-DWC-25Clinical notesInsurer authorization
Florida Division of Workers’ Compensation
03 / 14

New York

Narrative plus electronic billing

Routine treatment uses CMS-1500 with a medical narrative. OnBoard handles applicable prior authorization requests; C-4.3 remains for permanency.

CMS-1500 + narrativeOnBoard PARC-4.3 when applicable
New York Workers’ Compensation Board
04 / 14

Texas

A separate work-status report

The DWC-073 reports work status after an initial exam and on other qualifying events. MMI and impairment have a different report.

DWC-073Clinical documentationDWC-069 when applicable
Texas Department of Insurance
05 / 14

Washington

Functional capacity at the center

Initial reporting differs for state-fund and self-insured claims. The APF communicates work status and functional restrictions alongside clinical notes.

ROA or PIRAPFSOAPER notes
Washington Labor & Industries
06 / 14

Wyoming

Initial report plus ordinary notes

Wyoming lists a provider initial medical report and asks for medical notes supporting billed services.

Initial medical reportVisit notesCMS-1500 / UB-04
Wyoming Department of Workforce Services
07 / 14

North Dakota

Claim, capacity, and notes

WSI accepts a first report from several parties. Its C3 captures work capability; office notes can communicate MMI in the appropriate setting.

First Report of InjuryC3Medical notes
North Dakota Workforce Safety & Insurance
08 / 14

Pennsylvania

A recurring medical report

Pennsylvania’s LIBC-9 medical report accompanies treatment reporting, with billing and supporting documentation handled alongside it.

LIBC-9Clinical documentationMedical billing
Pennsylvania Department of Labor & Industry
09 / 14

Georgia

Medical report and request options

The Board lists WC-20a for medical reporting and WC-205 for an authorized provider’s treatment or testing authorization request.

WC-20aWC-205Visit documentation
Georgia State Board of Workers’ Compensation
10 / 14

North Carolina

Notes plus targeted forms

A medical-status questionnaire can organize work and treatment information. The Commission also lists separate forms for preauthorization and permanent impairment.

Medical-status questionnaire25PR25R
North Carolina Industrial Commission
11 / 14

Arizona

Combined injury report

Arizona offers a Worker’s and Physician’s Report of Injury for claim opening and a separate medical-treatment preauthorization form.

Worker/physician injury reportPreauthorization form
Industrial Commission of Arizona
12 / 14

Illinois

Narrative-led routine visits

The Commission recognizes ordinary office-visit documentation as a standard medical report. Other claim and payer requirements can still shape the case.

Office-visit notesClinical narrativePayer requirements
Illinois Workers’ Compensation Commission
13 / 14

Ohio

Treatment requests through managed care

Ohio’s C-9 lets providers request additional medical services or recommend additional conditions through a managed care organization or self-insuring employer.

C-9Treatment detailsSupporting documentation
Ohio Bureau of Workers’ Compensation
14 / 14

Oregon

Provider report plus chart notes

Form 827 can initiate a claim from the care setting. Clear chart notes help the insurer understand the condition and support ongoing care.

Form 827Chart notesWork restrictions
Oregon Workers’ Compensation Division

Reviewed September 27, 2026. These snapshots are orientation, not filing instructions. Requirements can depend on the visit, treating role, service, claim, and payer; verify the linked agency guidance for your case.

THE “STANDARD NARRATIVE” QUESTION

A visit note can be enough for one step—and not the next.

Some routine visits rely on familiar chart notes or a narrative attached to billing. New York and Illinois show that pattern; Wyoming and Oregon also rely on medical notes. Yet other milestones in those same states can call for a specific form or electronic request.

That is why we group narrative-led visit documentation as a workflow pattern, not as a blanket list of “form-free states.” Your clinic’s actual packet is the better starting point.

BRING YOUR EXISTING PACKET

Your forms are the starting point.

Show us the blank state, clinic, and employer forms your team uses. We’ll review the fields, signatures, and handoffs with you, then scope a digital workflow around them.

Review your form workflow Please share blank forms only through this initial inquiry—no patient information.