Medical Regulations Forms

The forms listed below are those commonly used in the Medical Regulation Unit functions of the workers' compensation system.

Medical Forms

Medical Status Form

Independent Medical Review Form (pdf)

Subsequent Injury Fund Forms

SIF Application (pdf)

SIF Release Form (pdf)

Re-Opening of Workers' Compensation Closed Medical Benefits Forms

Petition to Reopen Closed Medical Benefits (pdf)

Joint Agreement and Petition to Reopen Closed Medical Benefits (pdf)