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- Click ‘Get Form’ to open the dfs f5 dwc 9 form 2006 in the editor.
- Begin by filling out the demographic information in Items 1-8, including the insurer name, visit date, and injured employee details. Ensure all fields are legibly completed.
- Proceed to Section I for Clinical Assessment. Check the appropriate boxes regarding the work-related nature of the injury and provide necessary explanations for medical findings.
- In Section II, classify the patient’s condition by selecting one of the three levels based on their clinical assessment. This helps convey treatment needs effectively.
- Move to Section III to outline your management or treatment plan. Specify any referrals, diagnostic tests, or treatments required for the injured employee.
- Complete Section IV by detailing any functional limitations or restrictions based on your assessment. Be specific about activities that may be affected.
- Finally, fill out Section V regarding Maximum Medical Improvement and Permanent Impairment Rating if applicable. Ensure all relevant boxes are checked and provide comments as needed.
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