Get D - 35 - Nevada - Department Of Business And Industry - Dirweb State Nv

This guide provides a clear and supportive approach to filling out the D - 35 form required by the Nevada Department of Business and Industry. Users will learn the step-by-step process to complete this online document accurately.

Follow the steps to complete the D - 35 form online

1. Click ‘Get Form’ button to access the D - 35 form and open it within your preferred online document editor.
2. In the 'Name of Requestor' field, enter the full name of the person completing the form.
3. Fill in the 'Address', 'City', and 'State' fields with the requestor's current address information.
4. Indicate the 'Requestor is' field by selecting the appropriate option to define the requestor’s role, such as insurer, attorney, or other.
5. Provide the 'Date' and 'Phone' number for communication purposes.
6. Input the 'Insurer/Third-Party Administrator' or 'Self-Insured Employer's Name' as applicable.
7. For the 'Injured Employee's Name', enter the full name of the injured person.
8. Complete the 'Injured Employee's Address', ensuring clarity in the 'City', 'State', and 'Zip' fields.
9. Enter the 'Claim Number' associated with the employee's case and their 'Social Security Number' where required.
10. Fill out the 'Date of Injury' and provide all relevant details regarding the treating and evaluating doctors.
11. If making an additional request, ensure to fill in the details about previous evaluations and the reasons for the current request.
12. In the 'Assigned or Agreed by' section, enter the names of the individuals involved in the assignment/agreement.
13. Finally, review all entries for accuracy and completeness before saving your changes, downloading, printing, or sharing the form as needed.

Complete the D - 35 form online now to ensure timely processing of your request.