Overview: The Request for Authorization for Medical Treatment (DWC Form RFA) is required for the employee's treating physician to initiate the utilization ...

Complete the identifying information at the top of Form RFA-1W and send the form, WITH ALL APPLICABLE INFORMATION ATTACHED*, to: Workers' Compensation Board.

This form is for use by claimant's attorney or licensed representative ONLY. Unrepresented claimants should use Form RFA-1W or ask for Board assistance. 1. WCB ...

The requesting provider must complete: (1) the patient's name, date of birth, date of injury, employer, and claim number; (2) the claims administrator's name, ...

You may use this form for approving a treatment request. A request for additional information, or a decision to modify, delay, or deny a request for ...

DWC Form RFA. Expedited Review: Check box if employee faces an imminent and serious threat to his or her health. Check box if request is a written ...

Division of Workers' Compensation. Request for Authorization for Medical Treatment (DWC Form RFA). To accompany the Doctor's First Report of Occupational ...

Workers' Compensation Forms and Worksheets · C-1 Notice of Injury or Occupational Disease (Incident Report) (2/2020) · C-1 Fillable Form without Signature (2/2020) ...

Forms are grouped by relevant subject, then in alphabetical order. Use the arrows to change to reverse alphabetical order or search by form number. Online QME Form 106 Panel... · Medical mileage expense form

An RFA is a form that the doctor is required to use to request treatment, diagnostic tests or other medical services for an injured worker. If the treatment ...