Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send dwcca via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out the dwc document with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
Click ‘Get Form’ to open the dwc document in the editor.
Begin by indicating if this is a new case. Select 'Yes' or 'No' for companion cases as applicable.
Enter your Social Security Number (SSN) and the date of injury in the specified format (MM/DD/YYYY).
For each specific injury, fill in the case number, start date, and end date if applicable. Use the start date as the specific date of injury for specific injuries.
List affected body parts in the designated fields. You can refer to the body part code list provided within the document for accurate entries.
Select one box from the options provided for where to file your claim (e.g., ADJ, DEU, etc.).
Review all entered information for accuracy before saving or exporting your completed form.
Start using our platform today to streamline your form completion process for free!
The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, otherRead more
DWC Forms - California Department of Industrial Relations
Forms are grouped by relevant subject, then in alphabetical order. Use the arrows to change to reverse alphabetical order or search by form number.Read more
Cookie consent notice
This site uses cookies to enhance site navigation and personalize your experience.
By using this site you agree to our use of cookies as described in our Privacy Notice.
You can modify your selections by visiting our Cookie and Advertising Notice.
