Form 5021 Doctors First Report of Occupational Injury or Illness - California

What Is Form 5021?

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

FAQ

Q: What is Form 5021?
A: Form 5021 is called Doctors First Report of Occupational Injury or Illness.

Q: Who needs to fill out Form 5021?
A: Doctors or healthcare providers need to fill out Form 5021 when a patient has an occupational injury or illness.

Q: Why is Form 5021 important?
A: Form 5021 is important because it helps in reporting and documenting occupational injuries or illnesses.

Q: Do I need to submit Form 5021 to my employer?
A: No, as an employee, you do not need to submit Form 5021 to your employer. It is the responsibility of the doctor or healthcare provider.

Q: Are there any time limits for submitting Form 5021?
A: Yes, Form 5021 must be submitted to the DWC within five days of the initial examination of the employee.

Q: What information is needed on Form 5021?
A: Form 5021 requires information such as the employee's personal details, the nature of the injury or illness, and the treatment provided.

Q: What should I do if I have an occupational injury or illness?
A: If you have an occupational injury or illness, you should seek medical attention and inform your doctor that it is related to your work. They will then fill out Form 5021.

Q: Can I access my own Form 5021?
A: Yes, you have the right to request a copy of your own Form 5021 from the doctor or healthcare provider who filled it out.

Q: What happens after Form 5021 is submitted?
A: After Form 5021 is submitted, it becomes part of the employee's workers' compensation claim record and is used for evaluation and processing of the claim.