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Authorization For Release of Medical Records

I hereby authorize the Arkansas Workers’ Compensation Commission to release my medical records in its possession.

Type
PDF
Last Updated
2016-03-18

Authorization for Release of Protected Health Information

Authorization for release of protected health information (HIPAA compliant)

Type
PDF
Last Updated
2016-03-18

Banks Supplemental Application

Type
PDF
Last Updated
2016-07-19

Certificate of Compliance

You must submit this form to your employer's workers' compensation insurer or to your employer within 14 days of its receipt. Your workers' compensation benefits may be suspended if you do not timely submit this Certification. You would be entitled to all suspended benefits after this Certification is provided to your insurer, if you are otherwise eligible for benefits.

Type
PDF
Last Updated
2016-03-18

Certificate of Insurance Reference Guide

Type
PDF
Last Updated
2016-05-26

Choice of Physician

When you are injured at work or become sick because of something that happened at work, the law gives you the right to choose your own doctor in any field or specialty of medicine for medical treatment.

Type
PDF
Last Updated
2016-03-18

Choice of Physician

Employee’s Choice of Physician Form

Type
PDF
Last Updated
2016-03-18

Claims - Instructions for Reporting (OK)

Type
PDF
Last Updated
2020-04-09

Common Workers' Comp Terms

Type
PDF
Last Updated
2016-08-11

Contractor Questionnaire

Type
DOC
Last Updated
2020-04-24

Designated Workplace Exclusion

Type
PDF
Last Updated
2020-04-24

Designated Workplace Exclusion Request

Type
DOC
Last Updated
2016-05-26

Duties Should Claims Occur - AR

Type
PDF
Last Updated
2020-01-15

Duties Should Injury Occur - LA

Type
PDF
Last Updated
2020-01-15

Duties Should Injury Occur - MS

Type
PDF
Last Updated
2020-01-15

Showing 21 - 40 of 177 results