See all Workers' Compensation Bulletins and Forms
| Bulletin | Bulletin Name | Form - Form Name |
| 112 | Reimbursement of injured workers' travel, food, and lodging costs |
3921 - Request for Reimbursement of Expenses 3921s - Solicitud para reembolso de gastos (Request for Reimbursement of Expenses) |
| 239 | Claim closing and other impairment-focused examinations and forms for reporting impairments - Effective 6/1/10 |
2278c - Spinal (Cervical) Range of Motion 2278L - Spinal (Lumbar) Range of Motion 2278T - Spinal (Thoracic) Range of Motion 2279 - Upper Extremity Range of Motion Deformity/Deviation Amputation and Sensation 2312 - Visual Impairment 4841 - Lower Extremity Range of Motion 4842 - Shoulder Range of Motion |
| 247 | MCO quarterly reports -- Revised 9/09 | |
| 248 | MCO geographical service areas -- Revised 1/07 | |
| 251 | Change of attending physician or authorized nurse practitioner request -- Revised 1/08 |
2332 - Request to Change Attending Physician or Authorized Nurse Practitioner |
| 281 | Form 440-2476, "Request for release of medical records for Oregon Workers' compensation claim" -- Revised 3/12 |
2476 - Request for Release of Medical Records for Oregon Workers' Compensation Claim 2476s - Solicitud para Divulgar Expedientes Médicos para Reclamación de Compensación para Trabajadores de Oregon (Request for Release of Medical Records for Oregon Workers' Compensation Claim) (2476s) |
| 292 | Workers' compensation medical reporting forms -- Revised 12/15/11 |
827 - Worker's and Health Care Provider's Report for Workers' Compensation Claim 3245 - Release to Return to Work |
| 293 | Form and format for request for administrative review of medical disputes -- Revised 3/07 |
2842 - Request for Dispute Resolution of Medical Issues and Medical Fees 2842a - Medical Fee Dispute Resolution Request and Worksheet |
| 307 | Spanish translation, Form 440-827S |
827s - Reporte del Trabajador y del Proveedor Médico para Reclamaciones de Compensación para Trabajadores (827s) |
| 308 | Invasive medical procedures during an independent medical examination (IME) -- Effective 1/1/06 |
3227 - Invasive Medical Procedure Authorization (Autorización para Procedimiento Médico Invasivo) |
| 309 | Elective surgery notification form -- Revised 11/12 |
3228 - Elective Surgery Notification |
| 352 | Fee Discount Agreement form and reporting - Effective Jan. 1, 2009 |
3659 - Fee Discount Agreement |
| 361 | Clinical justification for certain drugs -- Effective 4/1/11 |
4909 - Pharmaceutical Clinical Justification for Workers' Compensation |
Questions? Contact us at 503-947-7606 or e-mail wcd.medicalquestions@state.or.us.
