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