Get Ca Dwc Pr-4 2014-2026

The Primary Treating Physician’s Permanent and Stationary Report (CA DWC PR-4) is an essential document for reporting a patient’s permanent impairment following a work-related injury. This guide provides practical steps for completing the form online, ensuring clarity and accuracy in each section.

Follow the steps to successfully complete the CA DWC PR-4 form online.

1. Press the ‘Get Form’ button to acquire the CA DWC PR-4 and open it in the online editor.
2. Complete the patient section by entering the last name, middle initial, first name, sex, date of birth, address, city, state, zip code, occupation, social security number, and phone number.
3. Fill out the claims administrator/insurer section, providing the name, phone number, and address of the claims administrator.
4. In the employer section, enter the required details such as the employer's name, phone number, and address.
5. Provide the treating physician’s information, including their name, phone number, and address.
6. Address the required issues by recording the date of injury, date of the last examination, date of permanent and stationary determination, and detailing how the injury occurred.
7. Document the patient's complaints, relevant medical history, and objective findings from the physical examination.
8. Enter diagnostic test results and list diagnoses, ensuring to include the corresponding ICD-10 codes.
9. Detail the impairment ratings based on the AMA Guides, including the whole person impairment percentage and the respective tables and page numbers used.
10. If applicable, specify any additional whole person impairment ratings attributable to pain, being careful to adhere to the limits on total pain impairment ratings.
11. Address apportionment of permanent disability, detailing the causation analysis and any relevant previous conditions.
12. Outline any anticipated future medical treatment required by the patient related to the injury.
13. Assess and record the functional capacity assessment, documenting lifting and carrying capacities, standing and walking capabilities, and any activity limitations.
14. Include any environmental restrictions that may affect the patient’s ability to work.
15. Finalize the report with the primary treating physician’s signature, printed name, medical specialty, and date, ensuring all information is truthful and complete.
16. After all sections are completed, you may save changes, download, print, or share the completed form as necessary.

Start filling out the CA DWC PR-4 form online today to ensure accurate reporting of your medical findings.