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Nevada Forms

81 State Forms found

name	number	revision	print or send online
AFFIRMATION OF COMPLIANCE WITH MANDATORY INDUSTRIAL INSURANCE REQUIREMENTS	D-25	(rev. 11/23)
EMPLOYER'S REPORT OF INDUSTRIAL INJURY OR OCCUPATIONAL DISEASE	Form C-3	(rev. 02/20)
Medical Provider Guide: Workers' Compensation	No Form Number	7/22
ALTERNATIVE CHOICE OF PHYSICIAN or CHIROPRACTOR	D-53	(Rev. 02/24)
APPLICATION FOR REIMBURSEMENT OF CLAIM RELATED TRAVEL EXPENSES	D-26	Rev. 4/04
ASSIGNMENT TO DIVISION FOR WORKERS' COMPENSATION BENEFITS	D-18	rev. 02/04
AUTHORIZATION REQUEST FOR ADDITIONAL CHIROPRACTIC TREATMENT	D-32	rev. 7/99
AUTHORIZATION REQUEST FOR ADDITIONAL PHYSICAL THERAPY TREATMENT	D-33	rev. 7/99
BRIEF DESCRIPTION OF RIGHTS AND BENEFITS	D-2	rev. 02/24
HEALTH INSURANCE CLAIM FORM	D-34	12-90
ELECTION FOR NEVADA WORKERS’ COMPENSATION COVERAGE FOR OUT-OF-STATE INJURY	D-15	rev. 7/99
Election of Coverage by Employer; Employer Withdrawal of Election of Coverage	D-44	(Rev.02/04)
ELECTION OF LUMP SUM PAYMENT OF COMPENSATION	D-10a	(Rev. 2/23)
ELECTION OF LUMP SUM PAYMENT OF COMPENSATION FOR DISABILITY GREATER THAN 30	D-10b	(rev. 2/23)
EMPLOYEE GUIDE WORKERS’ COMPENSATION	No Form Number	7/22

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Disclaimer: These forms may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.

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