Arizona Revised Statute § 23-908(A) stipulates that treating physicians shall file a Physician’s Initial Report of Injury with the Industrial Commission following a patient’s initial examination. The Arizona Administrative Code, R20-5-112 specifies that this report shall be completed and filed within 8 days and shall be made:
- Using Commission Form 102 (worker’s and physician’s report of injury), or
- By attaching to Form 102 a medical report that contains the information required in Form 102.
Both the physician and either the injured worker or their authorized representative are required to sign the report.
Report Form
Form 102 is required by the Industrial Commission of Arizona for a Physician’s Initial Report of Injury. The report must be made using or by attaching a report to the form.
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