Get the free DWC-9 WHPMP Inst Rev 1-1-07 May 07 2.doc

Form DFS-F5-DWC-9 B Completion Instructions Submitted by Work Hardening and Pain Management Programs A. Header Information Health Care Providers shall enter Insurer/Carrier name, address and zip code

How to fill out dwc-9 whpmp inst rev

How to fill out the DWC-9 WHPMP Inst Rev:

1. Begin by gathering all the necessary information and documents required to complete the form. This may include the injured worker's personal information, such as their name, address, and date of birth, as well as details about the injury or illness and any medical treatment received.
2. Review the instructions provided on the DWC-9 WHPMP Inst Rev form carefully. Familiarize yourself with the specific requirements and sections that need to be completed.
3. Start by filling out the worker's identification information accurately. This includes their name, address, phone number, and social security number. Double-check that all the information is entered correctly to avoid any inaccuracies in the document.
4. Proceed to the next section and provide details about the injury or illness. Describe how and when it occurred, the body parts affected, and any specific events leading to the incident. Be concise yet comprehensive in your description to ensure clear documentation.
5. Move on to the medical treatment section. Provide information about the healthcare provider who treated the worker, including their name, address, and contact details. Indicate the type of treatment received, such as medication, therapy, or surgery, and include any relevant dates.
6. If any witnesses were present during the incident, provide their names and contact information in the corresponding section. This can be crucial if further investigation or verification is required.
7. Review the completed DWC-9 WHPMP Inst Rev form for accuracy and completeness. Make sure all the necessary sections have been filled out correctly and that there are no missing or inconsistent information.

Who needs DWC-9 WHPMP Inst Rev?

1. Employers or their representatives who are responsible for reporting work-related injuries or illnesses require the DWC-9 WHPMP Inst Rev form. This includes cases where workers' compensation insurance claims are filed.
2. Injured workers who need to document their injuries or illnesses as part of the workers' compensation process will also need to complete the DWC-9 WHPMP Inst Rev form. This form helps provide a thorough overview of the incident and subsequent medical treatment.
3. Medical providers involved in the treatment and care of the injured worker may also require the DWC-9 WHPMP Inst Rev form to accurately document and report the details pertaining to the work-related injury or illness. This ensures proper communication and coordination between healthcare providers, employers, and insurance companies.

Note: It is always advisable to consult with relevant state authorities, legal professionals, or human resources departments to ensure compliance with specific state regulations and requirements regarding the DWC-9 WHPMP Inst Rev form.

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What is dwc-9 whpmp inst rev?

dwc-9 whpmp inst rev is a form used to report workers' compensation insurance information.

Who is required to file dwc-9 whpmp inst rev?

Employers who have workers' compensation insurance coverage are required to file dwc-9 whpmp inst rev.

How to fill out dwc-9 whpmp inst rev?

To fill out dwc-9 whpmp inst rev, you need to provide information about your workers' compensation insurance coverage, including policy number, coverage dates, and insurer details.

What is the purpose of dwc-9 whpmp inst rev?

The purpose of dwc-9 whpmp inst rev is to ensure that employers have workers' compensation insurance coverage for their employees.

What information must be reported on dwc-9 whpmp inst rev?

Information such as policy number, coverage dates, insurer details, and any changes in coverage must be reported on dwc-9 whpmp inst rev.