Get Dwc 25 Form

Filling out the Dwc 25 Form online can streamline the process of reporting medical treatment and status for injured employees. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Dwc 25 Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the demographic information. Complete items 1 to 4 and 6 to 8. Enter the insurance carrier name, current date of service, name and date of birth of the injured employee, and accident date.
3. Move on to Section I – Clinical Assessment. Check applicable boxes for Items 9 through 13 to indicate the patient's medical status and related findings. Be thorough in documenting objective medical findings associated with the injury.
4. Proceed to Section II – Patient Classification Level. Check boxes for Items 14 to 17 to accurately classify the patient's condition regarding required services and management.
5. In Section III – Management/Treatment Plan, specify the anticipated treatment needs. Check appropriate boxes for Items 18 to 20 and provide detailed medically necessary information.
6. Continue to Section IV – Determination of Functional Limitations and Restrictions. Complete items 21 to 23 to address the injured worker's capabilities and any limitations related to their work activity.
7. Then, move to Section V – Maximum Medical Improvement/Permanent Impairment Rating. Complete items 24 to 27 to report on the patient's medical improvement status and any disability ratings.
8. After completing the necessary sections, review the entire form for accuracy. If any additional information is required, attach supplementary sheets as needed.
9. Once you have reviewed the form, save your changes. You can then download, print, or share the completed Dwc 25 Form as required.

Complete your Dwc 25 Form online today for efficient medical reporting.