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Texas Department of Insurance - Division of Workers' Compensation Forms

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Form DWC067 Designated Doctor Certification Application - Texas PDF DOCX

Form DWC067 Designated Doctor Certification Application - Texas

This form is used for applying for certification as a designated doctor in the state of Texas.

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Formulario DWC046S Solicitud Para Acelerar Los Beneficios De Ingresos De Impedimento - Texas (Spanish) PDF DOCX

Formulario DWC046S Solicitud Para Acelerar Los Beneficios De Ingresos De Impedimento - Texas (Spanish)
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Form DWC052 Application for Supplemental Income Benefits - Texas PDF DOCX

Form DWC052 Application for Supplemental Income Benefits - Texas
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Form DWC EDI-02 Insurance Carrier or Trading Partner Medical Electronic Data Interchange (Edi) Profile - Texas PDF DOCX

Form DWC EDI-02 Insurance Carrier or Trading Partner Medical Electronic Data Interchange (Edi) Profile - Texas
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Formulario DWC057S Solicitud Para Extender La Fecha Del Mejoramiento Maximo Medico Para Una Cirugia Aprobada De La Columna Vertebral - Texas (Spanish) PDF DOCX

Formulario DWC057S Solicitud Para Extender La Fecha Del Mejoramiento Maximo Medico Para Una Cirugia Aprobada De La Columna Vertebral - Texas (Spanish)
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Form DWC EDI-03 Claim and Medical Edi Compliance Coordinator and Medical Edi Trading Partner Notification - Texas PDF DOCX

Form DWC EDI-03 Claim and Medical Edi Compliance Coordinator and Medical Edi Trading Partner Notification - Texas
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Form DWC154 Workers' Compensation Complaint Form - Texas PDF DOCX

Form DWC154 Workers' Compensation Complaint Form - Texas
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Form PC424 Form Usage Table - Short Version (Up to 90 Forms) - Texas PDF DOCX

Form PC424 Form Usage Table - Short Version (Up to 90 Forms) - Texas
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Form PC427 Form Usage Table - Long Version (Up to 470 Forms) - Texas PDF DOCX

Form PC427 Form Usage Table - Long Version (Up to 470 Forms) - Texas
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Form DWC057 Request to Extend the Date of Maximum Medical Improvement for an Approved Spinal Surgery - Texas PDF DOCX

Form DWC057 Request to Extend the Date of Maximum Medical Improvement for an Approved Spinal Surgery - Texas
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Form DWC020SI Self-insured Governmental Entity Coverage Information - Texas PDF DOCX

Form DWC020SI Self-insured Governmental Entity Coverage Information - Texas
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Formulario DWC042S Reclamacion Para Obtener Beneficios De Compensacion Para Trabajadores Por Causa De Muerte - Texas (Spanish) PDF DOCX

Formulario DWC042S Reclamacion Para Obtener Beneficios De Compensacion Para Trabajadores Por Causa De Muerte - Texas (Spanish)
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Form DWC042 Claim for Workers' Compensation Death Benefits - Texas PDF DOCX

Form DWC042 Claim for Workers' Compensation Death Benefits - Texas
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