Forms indexed in BWC’s medical repository

Note: The Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) is not indexed in the repository because managed care organizations (MCOs) are required to review and act on (approve or deny) the C-9 before forwarding it to BWC.

Document Type	Description	Rationale
C-1	For payment of compensation or medical benefits	First Report of Injury replaced this form, but BWC still receives a few of them.
C-140	Application for Wage Loss Compensation	Includes medical restrictions outlined by a physician
C-1-A	Attending Physician’s Report	See C-1 above.
C-11	Request to Appeal the MCO Medical Treatment/Service Decision	Form used by physicians to appeal an alternative dispute resolution decision
C-2	Application for Death Benefits	See C-1 above.
C-23	Notice to Change Physician of Record	Includes physician information
C-3	Application for Medical Benefits Only	See C-1 above.
C-5	Additional Information for Death Benefits	See C-1 above.
C-50	Self-Insured Claim Application	See C-1 above.
C-6	Accrued Compensation	See C-1 above.
C-63	Additional Information Request	A letter asking for additional medical information
C-84	Request for Temporary Total Compensation	This is a statement of medical disability.
C-86	Motion	This is a request for additional medical conditions.
C-92	Application for Determination of Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability	Determination of percentage of medical disability. Medical information is attached.
C-92EXA	C-92 exams	Determination of percentage of medical disability. Medical information is attached.
DELETED	Deleted document	Indexers use this for documents not included in this list.
FROI	First Report of Injury, Occupational Disease or Death	Workers’ compensation claim form
MED	Medical documents	Medical information that does not fit in the stated categories
MEDCO-14	Physician’s Report of WORK ABILITY	Form used by physicians for work restrictions
MEDCO-21	Physician Review	Form used by physicians for medical assessments
OD-1	Occupational Disease Application	See C-1 above.
OD-122	Self-Insured Occupational Disease Application	See C-1 above.
REHAB	Rehabilitation notes	Contains medical documents supporting the rehabilitation plan