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The document is a Primary Treating Physician's Permanent and Stationary Report (PR-4) required by the State of California's Division of Workers' Compensation. It is used by primary treating physicians to report on a patient's permanent impairment following an injury, detailing medical history, objective findings, diagnoses, impairment ratings, pain assessments, apportionment of disability, future medical treatment needs, and functional capacity assessments. The form emphasizes the need for thorough documentation regarding the causation of permanent disabilities and outlines legal requirements for reporting.

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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (56 Votes)
2005	4 Satisfied (41 Votes)
2005	4.2 Satisfied (34 Votes)

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What forms are required on a California workers comp policy?

If youve been injured on the job, you may be entitled to workers compensation benefits. In order to receive these benefits, youll need to fill out a C4 form. This form is used to report your injury to your employer and to the workers compensation insurance carrier.

What is a PR 4 rating?

The PR-4 form is required to be used for ratings prepared pursuant to the Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment. It is designed to be used by the primary treating physician to report the initial evaluation of permanent impairment to the claims administrator.

What is the difference between PR 2 and PR 4?

The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs: 5020 Employers Report of Occupational Injury or Occupational Disease. DWC-1 Workers Compensation Claim Form. Covered Employee Notification of Rights Material (English and Spanish). Wage Statement. First Fill Form.

What is a pr4 in medical terms?

PRIMARY TREATING PHYSICIANS PERMANENT AND STATIONARY REPORT(PR-4) This form is required to be used for ratings prepared pursuant to the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment (5th Ed.).

What is a PR 4 report?

The closing pressure of the PR-2 valve is externally adjustable while the PR-4 valve has a fixed setting. Air entering the supply port is blocked from flowing out the delivery port by the inlet valve, which is normally held closed by the pressure regulating spring above the piston.