Get Tx Dwc068 2018-2025

The TX DWC068 is a vital form used in the context of designated doctor examinations for workers' compensation claims in Texas. This guide will provide clear, step-by-step instructions on how to fill out the form online, ensuring that users can complete it accurately and efficiently.

Follow the steps to fill out the TX DWC068 online effectively.

1. Press the ‘Get Form’ button to access the TX DWC068 form and open it in your online editor.
2. Provide the injured employee claim information. Start with the employee's name, entering their last name followed by their first and middle names. Then include the last four digits of the Social Security Number and the name of the insurance carrier.
3. Indicate the date of injury by formatting it as mm-dd-yyyy. Make sure to check that all provided information is correct before proceeding.
4. In the examination information section, fill in the designated doctor’s name and their mailing address, including street, city, state, and ZIP code. Then, add the designated doctor's license number, jurisdiction, type, and phone number.
5. Enter the examination location with precise details including street address, city, state, and ZIP code. Record the date and time of the appointment.
6. Answer whether the claim involves medical benefits from a Certified Health Care Network. If yes, provide the network's name. Repeat this process for the inquiry about medical benefits from a political subdivision.
7. For the purpose of examination section, refer to the DWC Form-032 for details on extent of injury, disability results, or other issues. Clearly check 'Yes' or 'No' for each additional claimed diagnosis or condition.
8. If necessary, fill in the diagnosis codes for each claimed diagnosis, up to four per condition, and ensure to attach any additional pages for supplemental information.
9. Complete the additional testing or referral section by specifying the types of tests and evaluations performed during the examination.
10. Finally, the designated doctor must sign the form and date their signature. Review the entire document before submission.
11. Once all information has been entered accurately, save your changes, and you can download, print, or share the completed form as needed.

Complete your TX DWC068 form online to ensure a smooth filing process.