Webrequest for authorization must be set forth on a “Request for Authorization (DWC Form RFA),” completed by a treating physician, as contained in California Code of Regulations, title 8, section 9785.5. Prior to March 1, 2014, any version of the DWC Form RFA adopted by the Administrative Director under section 9785.5 may WebOverview: The Request for Authorization for Medical Treatment (DWC Form RFA) is required for the employee’s treating physician to initiate the utilization review process …

State of California Division of Workers’ Compensation …

WebMedical mileage expense form. If you need a medical mileage expense form for a year not listed here, please contact the Information and Assistance Unit at your closest district office of the Workers’ Compensation Appeals Board. Form name. Medical mileage expense form - English/Spanish. * For travel on or after 1/1/23. WebREQUEST FOR AUTHORIZATION DWC Form RFA - California Code of Regulations, title 8, section 9785. DWC Form RFA (version 07/2013) Page 1 This form must accompany the Doctor’s First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating ... Schedule (MTUS) found at California Code of Regulations, title 8, section 9792.20, et … fix back camera iphone 5

CLEAN COPY DWC Form RFA - EMPLOYERS

WebThe Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in … Web(1) Unless accepted by a claims administrator under section 9792.9.1(c)(2), a request for authorization must be set forth on a “Request for Authorization (DWC Form RFA),” … WebCalifornia Request for Authorization Treatment Request Form (DWC form RFA) Texas Fax Genex at 1-800-287-4028. Connecticut, Maine, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Requests should be emailed to Arbicare Email: [email protected] Fax: 1-404-631-6387 can lions beat tigers