Dwc 69 2026

1. Click ‘Get Form’ to open the DWC 69 in the editor.
2. 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.
3. 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.
4. In the 'Doctor’s Role' section, select the appropriate role you are serving in relation to the claim. This determines your authority to evaluate MMI and impairment.
5. Proceed to 'Medical Status Information'. Here, indicate whether the employee has reached Clinical or Statutory MMI and provide relevant dates.
6. Complete the 'Permanent Impairment' section if applicable. Certify whether there is permanent impairment and include any necessary documentation.
7. Finally, sign and date the form in the 'Doctor’s Certification' section to validate your report before submitting it through our platform.

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