Application for Independent Medical Review Form Number: DWC IMR
Doctor’s first report of occupational injury or illness Form Number: 5021
Primary treating physician’s permanent and stationary report Form Number: DWC PR-4
Primary treating physician’s progress report Form Number: DWC PR-2
Request for authorization for medical treatment Form Number: DWC Form RFA
Provider’s request for second bill review Form Number: DWC Form SBR-1
Request for independent bill review Form Number: DWC Form IBR-1
