The forms below are to be used after you have filed a workers’ compensation claim.
- Provider’s Initial Report (PIR) – Bring this report with you to the medical provider treating you for this injury. Your provider must complete this form.
- Activity Prescription Form (APF) – Bring this form with you to the medical provider treating you for this injury. Your medical provider will complete this form to indicate whether you are released to work.
- Corvel Pharmacy First Fill Letter – On your first pharmacy visit, give this notice to the pharmacist to expedite processing of approved prescriptions.
- Leave Claim Form – Complete this form if you missed work due to your injury and return to your school district.
- Transfer of Attending Physician – Use this form if you are changing medical providers.
- IME Travel & Wage Reimbursement Form – It may be necessary over the course of your claim that you attend an Independent Medical Exam (IME). Use this form to be reimbursed for eligible travel expenses.