Workers Compensation

Instructions

• Information to Know
• Claim Reporting Instructions

Report Medical Claim

• Notice to Medical Providers
• RXBridge First Fill Temporary Pharmacy Card

Report Notice/Incident

• Injury Illness Report
• Right of Refusal of Medical Aid

Certificate Requests

• Certificate Request Form

California Forms

• California Form (DWC 1) & Notice of Potential Eligibility
• Notice to California Employees (DWC7)
• EK Health MPN Notice (Bilingual)

High Risk and Foreign Travel

• Foreign Travel Form
• Hazardous Activity Form