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This form is used for filing a petition to suspend or revoke a Medical Provider Network (MPN) in California. It is a necessary step to report any concerns or issues with an MPN.
This Form is used for applying or renewing accreditation as an education provider in California. It provides instructions on how to complete the QME Form 118 Application.
This Form is used for requesting stipulations with a request for an award in a death case in California's DWC-CA system.
This form is used for supplementing the minutes of a hearing in the state of California. It provides additional information to ensure accuracy and completeness of the hearing record.
This Form is used for submitting a notice and request for allowance of a lien in the state of California through the Division of Workers' Compensation (DWC) and the Workers' Compensation Appeals Board (WCAB).
This form is used for California residents who hold a commercial driver's license to self-certify their medical status. It is necessary to comply with federal regulations for operating commercial vehicles.
This form is used for submitting a Compromise and Release - Dependency Claim in the state of California.
This form is used for filing a workers' compensation claim in California. It is available in both English and Spanish.
This Form is used for ordering legislative bills in California through the Legislative Bill Room.
This document is for designating a personal doctor in California. It is available in Spanish.
This form is used for primary treating physicians in California to report on the permanent and stationary status of the injured worker.
This form is used for reporting the permanent and stationary status of the primary treating physician in California workers' compensation cases.
This Form is used for filing a petition in California to appoint a guardian ad litem and trustee.
This form is used for filing a petition to reopen a workers' compensation case in the state of California.
This document is used for submitting an arbitration claim in California. It is a form that needs to be filled out and submitted to initiate the arbitration process.
This form is used for registering for the QME Competency Examination in California.
This Form is used for reporting personal chiropractic or personal acupuncture services in California.
This form is used for requesting a summary rating determination of the primary treating physician report in California. It helps with evaluating the rating for work-related injuries and determining the appropriate benefits for the injured worker.
This form is used for requesting a consultative rating in the state of California.
This form is used in California to request a reconsideration of the summary rating given by the Administrative Director.
This form is used to respond to an application for adjudication of a claim in the state of California. It allows the respondent to provide their answer to the claim.
This type of document is used in California to petition for the termination of liability for temporary disability indemnity in a workers' compensation case.
This document is a survey specifically designed for the California region regarding the secondhand smoke strategy of the Tobacco Prevention Coalition (TPC) Midwest Academy.
This form is used to notify individuals in California about an unsatisfied judgment of $1,000 or less.
This form is used for notifying the California Department of Health Care Services (DHCS) about changes in status regarding the Medi-Cal Inmate Eligibility Program (MCIEP) for county medical probation or compassionate release inmates.
This form is used for making amendments to the lobbying disclosure report in the state of California.
This document provides information about payments received by lobbying coalitions in California. It details the financial transactions and contributions made to these coalitions.
This form is used for reporting the lobbyist employer or lobbying coalition in California. It helps track and disclose the individuals or organizations that hire lobbyists and engage in lobbying activities.
This form is used for reporting individuals or groups who have spent $5,000 or more to influence legislative or administrative action in California.
This form is used for submitting a zoning affidavit in California. It is required for verifying compliance with zoning regulations for a specific property.
This Form is used for applying for a license to engage in the money transmission business in California.
This document is used for filing a notice of exemption under the Franchise Investment Law in California.
This form is used for reporting on fiduciary activities in California and the security deposits made with the State Treasurer of California.
This form is used for reporting fiduciary and related services in California.
This form is used for reporting foreign bank income to the state of California.
This Form is used for recording visitor information at a DBO (Department of Business Oversight) office in California. It serves as a visitors log to maintain a record of individuals who visit the office.
This Form is used for reporting income from foreign banks in California.