California Department of Industrial Relations - Division of Workers' Compensation Forms

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Documents:

166

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  • Name
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  • Size

The purpose of this form is to gather all of the information about an employee's case in the state of California and deliver it to the WCAB.

This form is used as a legal document and filled out by a treating physician of an employee with a work-related injury or illness to request authorization of special medical treatment, services, and procedures.

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