Dfs f5 dwc 9 form 2026

1. Click ‘Get Form’ to open the dfs f5 dwc 9 form in the editor.
2. Begin by entering the insurer or claim administrator's name, address, and ZIP code in the designated area at the top of the form.
3. In Field 1, select the type of claim. For Field 1a, input the insured’s ID number, which is required for processing.
4. Fill in the patient’s name in Field 2, ensuring to include their last name, first name, and middle initial if applicable.
5. For Fields 3 and 4, enter the patient's birth date and sex as well as the insured's name (the employer's business name).
6. Complete Field 5 with the patient's address including street, city, state, and zip code.
7. In Field 10, indicate if the patient’s condition is related to employment or an accident by marking 'A', 'B', or 'C'.
8. Finally, ensure all required fields are filled out accurately before submitting your form for processing.

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