Get the free DWC Form PR-3 (Rev. 06-05 10-14) DRAFT - dir ca

Print Form STATE OF CALIFORNIA Division of Workers Compensation PRIMARY TREATING PHYSICIANS PERMANENT AND STATIONARY REPORT (PR3) This form is required to be used for ratings prepared pursuant to

How to fill out dwc form pr-3 rev

How to fill out DWC form PR-3 rev:

1. Start by downloading the DWC form PR-3 rev from the official website or obtain a physical copy from the relevant authority.
2. Carefully read the instructions provided on the form to understand the purpose of each section and the information required.
3. Begin filling out the form by entering your personal information, including your name, contact details, and any relevant identification numbers.
4. Provide detailed information about the injury or illness that occurred, including the date, time, and location. Describe the nature of the incident and provide any additional information requested.
5. Indicate whether medical treatment was sought and provide details about the healthcare provider and any ongoing treatment being received.
6. If applicable, indicate whether any changes in employment occurred as a result of the injury or illness. Provide information about the date of return to work and any wage changes that may have occurred.
7. Include any additional information or remarks that may be relevant to the claim, ensuring that all required fields are completed accurately.
8. Review the completed form carefully, double-checking all information provided for accuracy and completeness.
9. Sign and date the form as required, indicating your understanding and agreement to the statements provided.
10. Make copies of the completed form for your records before submitting it to the appropriate authority.

Who needs DWC form PR-3 rev:

1. Individuals who have experienced a work-related injury or illness typically need to fill out the DWC form PR-3 rev.
2. Employers are often required to provide this form to their employees in order to initiate the workers' compensation claim process.
3. Healthcare providers may also need to complete certain sections of the form to provide medical information related to the injury or illness.

Remember to consult with the relevant authorities or seek professional advice if you have any specific questions or concerns while filling out the DWC form PR-3 rev.

For pdfFiller’s FAQs

What is dwc form pr-3 rev?

DWC Form PR-3 Rev is a form used for reporting work-related injuries and illnesses to the Division of Workers' Compensation.

Who is required to file dwc form pr-3 rev?

Employers are required to file DWC Form PR-3 Rev when an employee suffers a work-related injury or illness.

How to fill out dwc form pr-3 rev?

DWC Form PR-3 Rev should be filled out completely and accurately with information about the employee, the injury or illness, and any medical treatment received.

What is the purpose of dwc form pr-3 rev?

The purpose of DWC Form PR-3 Rev is to report work-related injuries and illnesses to the Division of Workers' Compensation for record-keeping and analysis.

What information must be reported on dwc form pr-3 rev?

Information such as the employee's name, address, employer information, date of injury or illness, description of the incident, and medical treatment received must be reported on DWC Form PR-3 Rev.

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