Please rate Texas Form Dwc022 Rev. 06-23
Section 3: Purpose of examination (Complete only Part 1 or Part 2)
Where to send: Fax: 512-804-4378.
Who signs: the employee only needs to sign the form when the purpose of the RME is for appropriateness of health care.
Health care network: the carrier can't request an exam for appropriateness of health care if the claim is in a health care network or political subdivision.
Rescheduling: the employee and RME doctor must contact each other 24 hours or earlier before the examination date to reschedule.
| Question | Answer |
|---|---|
| Form Name | Form DWC022 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 73 |
| Avg. time to fill out | 13 min |
| Edition | Rev. 06/23 |
| Where to send | Fax: 512-804-4378 |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | DWC022, DWC 022, DWC-022, Form DWC022, RME request, Request for a required medical examination |
| Official source | Form DWC022 (Rev Rev. 06/23), Texas Department of Insurance, Division of Workers' Compensation |
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Please rate Texas Form Dwc022 Rev. 06-23
