DWC Form 064 Medical Interlocutory Order Request - Continued Use of a Drug Previously Prescribed and Dispensed and Excluded From Tdi-DWC's Closed Formulary - Texas

What Is DWC Form 064?

This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DWC Form 064?
A: DWC Form 064 is a Medical Interlocutory Order Request.

Q: What is the purpose of DWC Form 064?
A: The purpose of DWC Form 064 is to request continued use of a drug that was previously prescribed and dispensed, but is excluded from TDI-DWC's closed formulary.

Q: What is TDI-DWC's closed formulary?
A: TDI-DWC's closed formulary is a list of drugs that are approved for use in Texas.

Q: Why would someone need to request continued use of a drug excluded from TDI-DWC's closed formulary?
A: Someone may need to request continued use of a drug excluded from TDI-DWC's closed formulary if they have been prescribed and dispensed that drug and it is necessary for their treatment.

Q: How can someone submit a request using DWC Form 064?
A: To submit a request using DWC Form 064, it should be completed by the prescribing doctor and submitted to the Texas Department of Insurance, Division of Workers' Compensation.

Q: Is there a fee for submitting DWC Form 064?
A: There is no fee for submitting DWC Form 064.