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Utilization Review and Independent Medical Review Regulations

8 C.C.R. §§ 9785, 9785.1, 9792.6 – 9792.10.5 (Approved 02/12/2014)

Checklist for Successful Represented QME Panel Request

 No Form Number no date

Example Medical Provider Network Application

 No Form Number no date

DWC Assignment of Unique Medical Provider Network Identification Numbers

 No Form Number 09/15/14

Participation in Workers’ Compensation Medical Provider Networks - Memo to Health Care Providers

 No Form Number no date

PUBLIC SELF-INSURERS MAILING LIST (nonJPA Roster)

No Form Number 10/13/2022

SAFETY AND HEALTH PROTECTION ON THE JOB

 No Form Number October 2020

PROTECCIÓN DE SEGURIDAD Y SALUD EN EL TRABAJO

 No Form Number Octubre de 2020

SUPPLEMENTAL JOB DISPLACEMENT NON-TRANSFERABLE VOUCHER FORM FOR INJURIES OCCURRING ON OR AFTER 1/1/13 (Chinese)

 DWC-AD 表格 10133.32 審核: 10/1/15

SUPPLEMENTAL JOB DISPLACEMENT NON-TRANSFERABLE VOUCHER FORM FOR INJURIES OCCURRING ON OR AFTER 1/1/13 (Korean)

 DWC-AD 양식 10133.32 수정: 10/1/15

SUPPLEMENTAL JOB DISPLACEMENT NON-TRANSFERABLE VOUCHER FORM FOR INJURIES OCCURRING ON OR AFTER 1/1/13 (Tagalog)

 DWC-AD Form 10133.32 Rev: 10/1/15

SUPPLEMENTAL JOB DISPLACEMENT NON-TRANSFERABLE VOUCHER FORM FOR INJURIES OCCURRING ON OR AFTER 1/1/13 (Vietnamese)

 Mẫu đơn DWC-AD 10133.32 Ngày sửa đổi: 10/1/2015

VERIFICATION (General)

 No Form Number April 2014
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