Dwc 25 form 2026

1. Click ‘Get Form’ to open the DWC 25 form in the editor.
2. Begin by filling out the demographic information in the designated fields, including insurer name, visit date, injured employee's name, date of birth, social security number, date of accident, and employer name.
3. Proceed to Section I for Clinical Assessment. Indicate if there has been no change since the last visit and check the appropriate box regarding whether the injury is work-related.
4. In Section II, classify the patient’s condition by selecting one of the three levels based on their medical status and treatment needs.
5. Complete Section III by detailing any proposed treatments or services required for recovery. Ensure all necessary boxes are checked and provide specific instructions as needed.
6. In Section IV, outline any functional limitations or restrictions that apply to the injured worker's activities. Be specific about which activities are affected.
7. Finally, review all sections for accuracy before signing in Section VII to attest that all information is correct and complete.

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