Forms

Forms are grouped by relevant subject, then in alphabetical order. Use the arrows to change to reverse alphabetical order or search by form number. The ten most-downloaded forms also appear in the “Frequently used forms” section.

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

• Audit forms
• Complaint forms
• Court forms
• Disability Evaluation forms
• Employer forms
• Independent Bill Review forms
  
• Independent Medical Review forms
• Lien forms

• Medical forms
• Medical Provider Network forms
• Pre-designation forms
• Public Records forms
• QME/AME forms
• SIBTF/UEBTF forms
• Supplemental Job Displacement Benefits forms

Frequently used forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

• Spanish - Chinese - Korean - Tagalog - Vietnamese

Audit forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Complaint forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Court forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

• Body part codes list
• Lista de códigos de las partes del cuerpo

• Changes to document separator sheet
  
• Document titles list

• See I&A guide 8 for more detailed instructions

• See I&A guide 7 for more detailed instructions

• Declaración Sobre Cobro De Honorarios

• See I&A guide 9 for more detailed instructions

• Note: A declaration of readiness to proceed must also be filed with this form.
  
• See I&A guide 11for more detailed instructions

Disability Evaluation forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Employer forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

• Spanish - Chinese - Korean - Tagalog - Vietnamese

Independent Bill Review forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Independent Medical Review forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

* For injured workers who need to get an independent medical review

Lien forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Medical forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Medical Provider Network forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Pre-designation forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Public records forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

QME/AME forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

SIBTF/UEBTF forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

Supplemental Job Displacement Benefits forms

Fillable form instructions - we recommend downloading forms to your desktop

Fillable form instructions = Fillable Adobe Acrobat form - en español = Adobe Acrobat for = Word form

• Spanish - Chinese - Korean - Tagalog - Vietnamese

Comments? Questions? Suggestions? Email dwc@dir.ca.gov

Division of Workers' Compensation (DWC)

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The Department of Industrial Relations (DIR) recognizes the importance of communicating effectively with individuals, including those with limited English proficiency. DIR is making an effort to provide meaningful services for individuals that speak languages other than English.

If you need to access information in a language other than English:

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