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Click ‘Get Form’ to open the DWC 69 in the editor.
Begin by filling in the 'General Information' section. Enter the injured employee's name, date of injury, and their Social Security number. Ensure accuracy as this information is crucial for processing.
Next, provide details about the certifying doctor, including their name, license type, and contact information. This section is vital for verifying the doctor's credentials.
In the 'Doctor’s Role' section, select the appropriate role you are serving in relation to the claim. This ensures compliance with Texas regulations regarding medical evaluations.
Proceed to 'Medical Status Information' where you will document the date of examination and diagnosis codes. Be thorough in your descriptions to avoid any discrepancies.
Finally, complete the 'Doctor’s Certification' section by signing and dating the form. This confirms that all provided information is accurate and complies with Texas Labor Code requirements.
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If the employee has DocHubed MMI, you must file the DWC Form-069 no later than the seventh working day after the later of: (a) date of the DocHubing examinationRead more
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