WC New Quantiferon Gold Mechanism of Injury Nurse Case Manager WC Recheck Subscriber Corporate Remedies BAT Hair Testing DWC69 Lift Test Authorization Form Chest X-Ray DOT Physical Providence Risk First Report of Injury eScreen Passport Audiogram Spirometry/PFT Post Accident Drug Screen TB Skin Test Adjuster to Schedule EPS Non- Subscriber Flu Shot Impairment Rating OccMed Work Queue Basic Physical DWC73 OSHA Physical Therapy Referral Referred Provider to Schedule WC New Quantiferon Gold Mechanism of Injury Nurse Case Manager WC Recheck Subscriber Corporate Remedies BAT Hair Testing DWC69 Lift Test Authorization Form Chest X-Ray DOT Physical Providence Risk First Report of Injury eScreen Passport Audiogram Spirometry/PFT Post Accident Drug Screen TB Skin Test Adjuster to Schedule EPS Non- Subscriber Flu Shot Impairment Rating OccMed Work Queue Basic Physical DWC73 OSHA Physical Therapy Referral Referred Provider to Schedule
(Print)
WC New
Quantiferon Gold
Mechanism of Injury
Nurse Case Manager
WC Recheck
Subscriber
Corporate Remedies
BAT
Hair Testing
DWC69
Lift Test
Authorization Form
Chest X-Ray
DOT Physical
Providence Risk
First Report of Injury
eScreen Passport
Audiogram
Spirometry/PFT
Post Accident Drug Screen
TB Skin Test
Adjuster to Schedule
EPS
Non-Subscriber
Flu Shot
Impairment Rating
OccMed Work Queue
Basic Physical
DWC73
OSHA
Physical Therapy Referral
Referred Provider to Schedule
