It is designed to be used by the primary treating physician to report the initial evaluation of permanent disability to the claims administrator. It should be completed if the patient has …

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 …

This form is required to be used for ratings prepared pursuant to the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment (5th Ed.). It …

Primary Treating Physician's Permanent and Stationary Report (Form PR-4) Note: Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 4600, 4061.5, 4603.2, 4636, …

Mar 15, 2017 · When the PTP determines that the injured employee's condition is both permanent and stationary, the PTP must issue either a PR-3 or PR-4 report to the claims administrator …

Physicians must report on permanent and stationary determinations within 20 days. For injuries using the 2005 Permanent Disability Rating Schedule, use the new DWC Form PR-4 effective …

It is designed to be used by the primary treating physician to report the initial evaluation of permanent impairment to the claims administrator. It should be completed if the patient has …

The information may be submitted on the “Primary Treating Physician's Permanent and Stationary Report” form (DWC Form PR-3 or DWC Form PR-4) contained in section 9785.3 or section …

May 12, 2023 · A PR4 report includes the injured worker's identification information, medical history, examination findings, diagnosis, prognosis, and treatment plan and work restrictions. …