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PD-45 Attachment D Texas Department of Criminal Justice DWC FORM-73 Notification Beginning May 1, 2006, health care providers must use the DWC FORM-73, Texas Workers Compensation Work Status Report,

How to fill out dwc73 form

How to fill out the DWC73 form:

1. Start by obtaining a copy of the DWC73 form. You can usually find it on the official website of your state's workers' compensation division or by contacting the relevant authority.
2. Carefully read and understand the instructions provided on the form. Each section of the form will have specific requirements and information that need to be filled out correctly.
3. Begin by entering the worker's personal information, such as their full name, contact details, and social security number. Ensure that all the information provided is accurate and up to date.
4. Move on to the employer details section and fill in the necessary information about the employer, including their business name, address, and contact information. This is crucial for accurately identifying the employer involved.
5. In the next section, provide details about the injury or illness being reported. Clearly describe how the injury or illness occurred, including the date, time, and location. Be as specific as possible to help facilitate the claims process.
6. If applicable, provide details about any medical treatment received as a result of the injury or illness. This may include the healthcare provider's name, the services provided, and any medications or treatments administered.
7. Towards the end of the form, you might need to include information about the claim administrator or the insurance company handling the workers' compensation claim. This may involve providing their contact information and any claim or policy numbers you have received.
8. Review the completed form for accuracy and ensure that all necessary information has been provided. Double-check spellings, dates, and other critical details to avoid any potential delays or issues with your claim.

Who needs the DWC73 form:

1. Employers: Employers who have an employee who has suffered a work-related injury or illness that may be covered by workers' compensation insurance will need to complete the DWC73 form. This allows them to initiate the claims process and provide necessary details about the incident.
2. Injured workers: Employees who have sustained a work-related injury or illness need the DWC73 form to report their incident to the relevant authority. Filling out this form accurately helps ensure that their claim is processed promptly and that they receive the appropriate benefits and medical treatment.
3. Medical providers: Healthcare providers who have treated an injured worker and wish to document the services they provided as part of the workers' compensation claim process may be required to complete specific sections of the DWC73 form.

In summary, the DWC73 form is necessary for both employers and employees involved in a work-related injury or illness. By carefully following the instructions and accurately filling out the form, all parties can help streamline the claims process and ensure the proper handling of workers' compensation cases.

For pdfFiller’s FAQs

What is dwc73 form?

The DWC73 form is a medical treatment form used in workers' compensation cases.

Who is required to file dwc73 form?

Employers or insurance carriers are required to file the DWC73 form.

How to fill out dwc73 form?

The DWC73 form should be filled out with accurate information regarding the employee's medical treatment.

What is the purpose of dwc73 form?

The purpose of the DWC73 form is to document and track the medical treatment received by an injured employee.

What information must be reported on dwc73 form?

The DWC73 form must include details such as the employee's name, injury information, medical treatment provided, and physician's recommendations.

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