The State of California's Division of Workers' Compensation requires the use of the PRIMARY TREATING PHYSICIAN’S PERMANENT AND STATIONARY REPORT (PR-4) form to evaluate and report the extent of a worker's permanent impairments following an injury or illness related to their job. This critical document, based on guidelines from the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, must be completed by the worker's primary treating physician once the patient’s condition has stabilized and is deemed permanent and stationary. The form serves multiple purposes, including the initial evaluation of permanent impairment, determination of future medical care needs, and the assessment of the patient's functional capacity with respect to their usual occupation. It is integral for calculating impairment ratings and considering the necessity of future medical treatment. Additionally, it addresses the causation of the permanent disability, requiring a breakdown of what percentage is directly related to the work injury versus other factors, which may include previous injuries or pre-existing conditions. This thorough and structured documentation not only facilitates the determination of appropriate compensation for the injured worker but also outlines their capacity for returning to work, making it a pivotal piece of the workers' compensation process.
| Question | Answer |
|---|---|
| Form Name | Dwc Form Pr 4 |
| Form Length | 7 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 45 sec |
| Other names | dwc form pr 4, form pr 4, dwc pr4, pr4 workers comp |