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RI Workers' Compensation Forms: Medical Forms

To see or print PFD forms , you must have Adobe Acrobat Reader.  Some of the forms will only display properly with Adobe Acrobat Version 4 or higher.  Download the latest version of Acrobat Reader software free from Adobe.  Right click on a form to save a copy on your PC.
Medical Forms Right click on a form to save a copy on your PC.
Form Title Form Number       Revised Purpose Form Form Type
Medical Fee Schedule Order Form Please see our Medical Fee Schedule Information Page
Notification of Claim of Compensable Injury  DWC-29 04/02 Purpose DWC-29 PDF Fill-in

Physician's Notice of Release to Work

DWC-27/28

 04/02 Purpose DWC-27/28 PDF Fill-in

Request for Additional Palliative Care

 DWC-40 04/05 Purpose DWC-40 PDF Fill-in

For additional workers' compensation medical forms, please see the Medical Advisory Board's web page on forms.

 
 
If you have any questions or comments about medical forms, please contact the Education Unit's Information Line at (401) 462-8100 option 1 or WCEdcUnit@dlt.ri.gov

For information on workers' compensation, please contact the Information Line at (401) 462-8100 option 1, or WCEdcUnit@dlt.ri.gov

To comment on this site, please contact the WC web staff at (401) 462-8023 or WCWebmaster@dlt.ri.gov

This page was last updated on 5/30/06.
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