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0000148552 00000 n 0000044917 00000 n DO NOT SEND THIS AGREEMENT TO TDI-DWC . 0000118924 00000 n 0000201238 00000 n
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DWC UR 1: … TEXAS WORKERS’ COMPENSATION WORK STATUS REPORT Empleado - Es necesario que reporte su lesión a su empleador dentro de 30 días a partir de la fecha en que se lesionó si es que su empleador cuenta con un seguro de compensación para
0000061342 00000 n 0000117369 00000 n 0000149679 00000 n 0000136692 00000 n 0000049336 00000 n 0000177616 00000 n
TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION (TDI-DWC) 7551 Metro Center Drive, Suite 100 . 0000084856 00000 n 02/11) Page 1. 0000108279 00000 n 0000188925 00000 n 0000086063 00000 n 0000117043 00000 n
0000036865 00000 n 0000130507 00000 n 0000101424 00000 n 0000047433 00000 n 0000125751 00000 n 0000180785 00000 n Download a blank fillable Dwc Form-73 - Texas Workers' Compensation Work Status Report in PDF format just by clicking the "DOWNLOAD PDF" button.
0000134439 00000 n Number Complaint form: Utilization review - word version * Note: If you want to save this form to your computer and email it to the DWC Medical Unit, you MUST use the Word version. 0000191751 00000 n 0000122831 00000 n 0000133887 00000 n 0000094346 00000 n 0000191914 00000 n 0000197671 00000 n 0000099619 00000 n 0000131287 00000 n 0000196762 00000 n 0000216218 00000 n Austin, Texas 78744 . 0000034255 00000 n 0000058249 00000 n 0000041598 00000 n
0000033101 00000 n 0000228851 00000 n 0000084232 00000 n 0000213027 00000 n 0000046472 00000 n 0000050267 00000 n 0000109573 00000 n 0000203966 00000 n 0000082468 00000 n
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0000169782 00000 n 0000048459 00000 n 0000182066 00000 n No, explain belowIf a Job Description has been provided, please complete: Employee Last Name Claim No.
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0000173763 00000 n 0000170130 00000 n 0000123813 00000 n 0000205806 00000 n 0000259818 00000 n 07/04) Page 2 TEXAS WORKERS' COMPENSATION COMMISSION FORM TWCC-73 WORK STATUS REPORT INSTRUCTIONS PART I: GENERAL INFORMATION - Contains space to record general information about the employee and the doctor/clinic. 0000162510 00000 n 0000061595 00000 n 0000224247 00000 n 0000224495 00000 n 0000052901 00000 n 0000102723 00000 n 0000073722 00000 n
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03/16 PDF: English: … 0000060664 00000 n 0000129176 00000 n
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4ÉûÈkÑ�º/>|8|Á-f)r¥km”~Vå´=‹cÛ�úysN«œí?ÈcSü�ô-§%Ñâ(œ˜ SR“t0*W…š#PyÒµ8›HŠlş¼}?çÈÖ´¿x…ìú@Æ"«ô(Q„ xref 0000221931 00000 n 0000160259 00000 n 0000033536 00000 n 0000054535 00000 n
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0000068759 00000 n 0000086411 00000 n 0000068117 00000 n
0000179795 00000 n 0000040319 00000 n Filing requirements for DWC Form-073 vary depending on the type of doctor filing the Work Status Report. 0000072581 00000 n 0000123139 00000 n
0000087342 00000 n 0000105196 00000 n 0000075581 00000 n 0000110679 00000 n
0000060316 00000 n 0000054887 00000 n
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0000051347 00000 n DWC AD Form 10133.36 (SJDB) Eff: 1/1/14. 0000054456 00000 n 0000257084 00000 n
0000111646 00000 n 0000215798 00000 n 0000079619 00000 n 0000113799 00000 n
0000167336 00000 n dwc form-73 (rev. 0000089769 00000 n 0000046551 00000 n 0000163330 00000 n 0000088645 00000 n 0000098204 00000 n
0000194402 00000 n
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