2006年6月25日 · The provider must complete form DFS-F5-DWC-25 to request authorization for a medical treatment plan, to communicate to the carrier an injured employee’s medical status, to document the injured employee’s date of Maximum Medical Improvement (MMI date), and to document a Permanent Impairment Rating (PI Rating).

LEVEL I - Key issue: specific, well-defined medical condition, with clear correlation between objective relevant physical findings and patients' subjective complaints.

Form DFS-F5-DWC-25 (revised 5-26-05) Page 2 of 2

Florida Workers' Compensation Uniform Medical Treatment/Status Reporting Form - PAGE 2 ... Assignment of limitations or restrictions must be based upon the injured employee's specific clinical dysfunction or status related to the work injury.

A DWC 25 form is a state regulatory document used by the medical provider to inform about the medical evaluation, work status, treatment plan, and precautions for the injured worker. It is only applicable in Florida state to meet the workers’ compensation criteria during a workplace injury.

GENERAL INFORMATION The Form DFS-F5-DWC-25 has been adopted by the Florida Division of Workers’ Compensation in Rule 69L-7.602, F.A.C., as the required reporting form for physicians to recommend medical treatment/ services and report the medical status of the injured employee to insurers/employers including the

LEVEL I - Key issue: specific, well-defined medical condition, with clear correlation between objective relevant physical findings and patients' subjective complaints. Treatment correlates to the specific findings.

2015年1月1日 · Physicians completing the Form DFS-F5-DWC-25 must apply the following guidelines: • Accurate completion and submission of the Form DFS-F5-DWC-25 does not fulfill the