FORMS

Disclaimer - Many of these forms are accessed through links to other web sites and may take additional time to open them. Some documents require a third party program to open them, see bottom of the page for instructions.

Reports and Forms for Medical Providers
Doctors First Report of Occupational Injury or Illness (5021)
Primary Treating Physicians Progress Report (PR-2)
Primary Treating Physicians Permanent and Stationary Report (PR-3)
Treating Physicians Report of Disability Status (RU-90)
Description of Employee's Job Duties (RU-91)
HCO - Grievance Form
Return to Work Slip

Reports and Forms for Employers
Employers First Report of Injury or Illness (5020)
Application for CompPartners HCO Services
HCO - Employers HCO Kit (Enrollment Guide)
HCO - Employee Census Form
HCO - Grievance Form

Forms for Employees
Enrollment and Membership Information Brochure (English)
Enrollment and Membership Information Brochure (Spanish)
Enrollment and Membership Information Brochure (Chinese)
Enrollment and Membership Information Brochure (Vietnamese)
State Enrollment Form (English)
State Enrollment Form (Spanish)
State Enrollment Form (Chinese)
State Enrollment Form (Vietnamese)
Confirmation Letter (English/Spanish)
Confirmation Letter (Chinese)
Confirmation Letter (Vietnamese)
HCO - Grievance Form

 
 
 
   
 
Designed by Michael Frazier