FORMS
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Reports and Forms for Medical Providers
Doctors First Report of Occupational Injury or Illness (5021)
Primary Treating Physicians Progress Report (PR-2)
Primary Treating Physicians Permanent and Stationary Report (PR-3)
Treating Physicians Report of Disability Status (RU-90)
Description of Employee's Job Duties (RU-91)
HCO - Grievance Form - 77kb
Return to Work Slip - 29kb
Reports and Forms for Employers
Employers First Report of Injury or Illness (5020)
Application for CompPartners HCO services - 41kb
HCO - Employers HCO Kit (Enrollment Guide) - 87kb
HCO - Employee Census Form - 38kb
HCO - Grievance Form - 77kb
Forms for Employees
Enrollment and Membership Information (English)
Enrollment and Membership Information (Spanish)
Enrollment and Membership Information (Chinese)
Enrollment and Membership Information (Vietnamese)
Enrollment Form (English)
Enrollment Form (Spanish)
Enrollment Form (Chinese)
Enrollment Form (Vietnamese)
Confirmation Letter (English/Spanish)
Confirmation Letter (Chinese)
Confirmation Letter (Vietnamese)
HCO - Grievance Form - 77kb
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