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DWC Petition for Suspension or Revocation of a Medical Provider Network Form 9767.17. 5 (Part B). Note: Authority cited: Sections 133 and 4616, Labor Code.DWC PETITION FOR SUSPENSION OR REVOCATION OF A MEDICAL PROVIDER NETWORK FORM 9767.17. 5 (PART B) Forms ; Downloads ; Form State, California ; Language, English. Adopt Section 9767.17. 5 DWC Petition for Suspension or Revocation of a Medical Provider Network Form 9767.17.5. Download MPN response to petition for suspension or revocation of a medical provider network - Part B (DWC 9767.17. The Administrative Director is also empowered under Regulation Section 9767. 14 to suspend or revoke a MPN. Notice of medical provider network plan modification, DWC 9767.