Doctor's First Report of Occupational Injury or Illness

Form #:CA-WC-5021
This form is used by a doctor upon their first examination of an injured employee. Included on the form will be specific information about the occurrence of the injury, treatment, and diagnosis. Within five days of the examination, one copy is to be sent to the insured employer or the employer's insurance carrier.

Name:Doctor's First Report of Occupational Injury or Illness
Form Number: CA-WC-5021
State:California
Statute:
Form Category:Workers' Compensation

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