Medical Forms

1. Notification of Claim of Compensable Injury DWC-29

This form needs to be submitted to the insurer within 3 days of initial visit with a copy for the employee and the attorney.

2. Physician's Notice of Release to Work DWC-27/28

This form needs to be submitted to the insurer within 3 days of release to work with a copy for the employee and the attorney.

3. Request for Additional Palliative Care DWC-40

For additional workers' compensation medical forms, visit the Medical Advisory Board..

If you have questions or comments about medical forms, please contact the Education Unit at:

(401) 462-8100
DLT.WCEdcUnit@dlt.ri.gov