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Primary treating physician's permanent and stationary report - DWC PR-4

For injuries which occurred on or after January 1, 2005, when the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the "Primary Treating Physician's Permanent and Stationary Report" form (DWC Form PR-4).

Frequently Asked Questions

Q: Which version of the form do providers need to use?

A: As of January 1, 2016, providers must use the new 2015 version of the DWC Form PR-4, which incorporates ICD-10 diagnosis codes.

Explanation

California Code of Regulations § 9785.(h) Reporting Duties of the Primary Treating Physician:

When the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall, unless good cause is shown, report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the “Primary Treating Physician's Permanent and Stationary Report” form (DWC Form PR-3 or DWC Form PR-4) contained in section 9785.3 or section 9785.4, or in such other manner which provides all the information required by Title 8, California Code of Regulations, section 10606. For permanent disability evaluation performed pursuant to the permanent disability evaluation schedule adopted on or after January 1, 2005, the primary treating physician's reports concerning the existence and extent of permanent impairment shall describe the impairment in accordance with the AMA Guides to the Evaluation on Permanent Impairment, 5th Edition (DWC Form PR-4). Qualified Medical Evaluators and Agreed Medical Evaluators may not use DWC Form PR-3 or DWC Form PR-4 to report medical-legal evaluations.”

For injuries which occurred on or after January 1, 2005, when the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the "Primary Treating Physician's Permanent and Stationary Report" form (DWC Form PR-4).

As of January 1, 2016, providers must use the new 2015 version of the DWC Form PR-4 which incorporates ICD-10 diagnosis codes.

Download the New PR-4 Form

Primary treating physician's progress report - DWC PR-4

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Primary treating physician's progress report - DWC PR-4

Additional Information

California Code of Regulations § 9785(h)

DWC Forms Page

DWC ICD-10 page

DIR Newsline No.: 2015-86

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