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This document serves as a report for the primary treating physicians regarding permanent and stationary status under the California permanent disability rating schedule.
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How to fill out dwc pr 4
How to fill out DWC PR 4
01
Obtain the DWC PR 4 form from the appropriate state agency or website.
02
Read the instructions carefully to understand the requirements.
03
Fill out the worker information section with accurate personal details.
04
Complete the employer information section with the employer's details.
05
Provide the relevant accident or injury information in the designated section.
06
Ensure all dates are correct, especially the date of injury.
07
Review the form for any missing information or errors.
08
Sign and date the form before submission.
09
Submit the completed form to the designated agency either by mail or electronically.
Who needs DWC PR 4?
01
Workers who have sustained an injury or illness in the workplace.
02
Employers who are required to report work-related injuries or illnesses.
03
State agencies responsible for overseeing workers' compensation claims.
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What is DWC PR 4?
DWC PR 4 is a form used in California to report injuries to the Division of Workers' Compensation, specifically related to the initial claim report for workers' compensation cases.
Who is required to file DWC PR 4?
Employers who have an employee that sustains a work-related injury or illness are required to file DWC PR 4.
How to fill out DWC PR 4?
To fill out DWC PR 4, employers need to provide information such as the employee's personal details, the nature of the injury, the date of occurrence, and any medical treatment sought.
What is the purpose of DWC PR 4?
The purpose of DWC PR 4 is to provide a standardized method for employers to report workers' compensation claims and ensure that injured employees receive appropriate benefits.
What information must be reported on DWC PR 4?
The information that must be reported on DWC PR 4 includes the employee's name, address, Social Security number, date of birth, details of the injury, date of injury, and employer's information.
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