Section R20-5-112. Physician’s Initial Report of Injury

A.      A physician shall complete and file with the Commission a physician’s initial report of injury under A.R.S. § 23-908(A) within eight days after first providing treatment to an injured worker. The physician shall report the injury:

1.        Using Commission form 102 (worker’s and physician’s report of injury), or

2.        Attaching to form 102 a medical report that contains the information required in form 102.

B.       The physician shall sign and date form 102 or the medical report attached to form 102. The signature of the physician may be typewritten or stamped on this form.

C.      If a claimant uses form 102 to initiate a claim, either the injured worker or the injured worker’s authorized representa- tive shall sign the worker’s portion of form 102.

Historical Note

Former Rule 12. Amended effective March 1, 1987, filed

February 26, 1987 (Supp. 87-1). Amended effective

August 28, 1992 (Supp. 92-3). R20-5-112 recodified from R4-13-112 (Supp. 95-1). Amended by final rulemaking at 7 A.A.R. 3966 and 7 A.A.R. 4995, effec-

tive August 17, 2001 (Supp. 01-3).