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STATE OF CALIFORNIADOCTOR\'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS Within 5 days of your initial examination, for every occupational injury or illness, send two copies of this report to the

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How to fill out dwc form 5021 doctors

01

Obtain the DWC form 5021 from your employer or the workers' compensation board.

02

Fill out the patient's information, including name, address, and contact information.

03

Provide details of the injury or illness that the patient is seeking treatment for.

04

Include the date of the injury or illness and any relevant medical history.

05

Complete the section for the doctor's examination findings and treatment plan.

06

Sign and date the form as the treating physician.

07

Submit the completed form to the appropriate party as instructed.

Who needs dwc form 5021 doctors?

01

Employees who have been injured on the job and are seeking medical treatment through workers' compensation.

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What is dwc form 5021 doctors?

DWC Form 5021 doctors is a form used by doctors to report work-related injuries and illnesses to the Division of Workers' Compensation.

Who is required to file dwc form 5021 doctors?

Doctors who treat workers with work-related injuries or illnesses are required to file DWC Form 5021.

How to fill out dwc form 5021 doctors?

To fill out DWC Form 5021, doctors need to provide information about the injured worker, the nature of the injury or illness, and the treatment provided.

What is the purpose of dwc form 5021 doctors?

The purpose of DWC Form 5021 is to ensure that accurate and timely information about work-related injuries and illnesses is reported to the Division of Workers' Compensation.

What information must be reported on dwc form 5021 doctors?

Doctors must report information such as the injured worker's name, employer, date of injury, nature of injury, treatment provided, and any other relevant details.

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