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Physicians Report - Connecticut 2026

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The document is a Physician's Report of Medical Evaluation for Permanent Medical Impairment from the State of Connecticut Workers' Compensation Commission. It includes sections for injured worker information, employer/insurer details, and an assessment of medical impairment, including evaluations of body parts or organs affected by injury. The report requires the physician to provide their findings on the patient's condition, potential work capacity, and any recommendations for further evaluations.

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Click ‘Get Form’ to open the Physicians Report - Connecticut in the editor.
Begin by filling out the 'Injured Worker Information' section. Enter the patient's name, Social Security number, and date of injury.
Next, complete the 'Employer/Insurer Information' section. Provide the employer's name and contact details for the party requesting the evaluation.
In the 'Body Part(s) or Organ(s) Being Evaluated' field, specify which parts of the body are affected. If applicable, indicate if it involves a limb and whether it's left or right.
For eye injuries, clearly state which eye was injured and detail any loss of sight in the respective fields provided.
Complete the clinical evaluation section by entering your assessment date and any standards utilized during your evaluation.
Finally, provide your medical opinion regarding work capacity and whether a physical capacities evaluation is necessary before signing and dating the report.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to find a doctor in Connecticut?

To find a licensed health care provider in Connecticut, go to the DPH website, , and click on Verify a License and Roster, then click on Health Care Practitioners.

Is there a shortage of doctors in Connecticut?

Connecticut is not immune with almost 20% of residents already living in designated Health Professional Shortage Areas (HPSAs) with fewer than one primary care physician per 3,500 residents. This critical shortage has dire consequences for the health of Connecticut residents.

How long do doctors keep medical records in Connecticut?

Unless specified otherwise herein, all parts of a medical record shall be retained for a period of seven (7) years from the last date of treatment, or, upon the death of the patient, for three (3) years.

How do I report a doctor in Connecticut?

You may also call the Practitioner Investigations Unit at 860-509-7552 to request a complaint form be mailed to you.

How do I look up a complaint against a doctor?

For older violations, contact Californias medical board at 916-263-2525 or complete the online request form.

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Is it worth filing a complaint against a doctor?

If you have experienced unprofessional conduct or inadequate care at the hands of a doctor, it is important that you file a complaint with the state medical board in your state. The Federation of State Medical Boards (FSMB) provides contact information for every state medical board in the U.S. and its territories.

What is the best way to file a complaint against a doctor?

To file a complaint against a physician or specialist, contact your state medical board.