Oklahoma > Workers Comp
Request For Court Forms RMD-003 - Oklahoma
| Request For Court Forms Form. This is a Oklahoma form and can be used in Workers Comp . |
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RMD-003 (Revised 5/09/08) OKLAHOMA WORKERS' COMPENSATION COURT 1915 NORTH STILESOKLAHOMA CITY, OK 73105-4918(405)522-8640 REQUEST FOR COURT FORMS THE FOLLOWING COURT FORMS ARE AVAILABLE FREE OF CHARGE FROM THE WORKERS' COMPENSATION COURT. They also may be downloaded from the Court's web site at www.owcc.state.ok.us. TO ORDER, COMPLETE THIS FORM AND SEND IT TO THE WORKERS' COMPENSATION COURT AT THE ABOVE ADDRESS, ATTENTION: FORM REQUEST. YOU MUST INCLUDE A SELFADDRESSED, STAMPED ENVELOPE LARGE ENOUGH TO ACCOMMODATE THE QUANTITY OF FORMS ORDERED. CALCULATE POSTAGE USING THE CHART BELOW. ALL FORMS EXCEPT FORM 1A FORM 1A Quantity 1-5 42¢ 1 42¢ 6-11 83¢ 2-5 83¢ 12-17 $1.00 6-8 $1.00 18-24 $1.17 9-11 $1.17 25-30 $1.34 12-14 $1.34 31-36 $1.51 15-17 $1.51 Quantity 37-42 $1.68 18-20 $1.68 43-49 $1.85 21-23 $1.85 50-55 $2.02 24-25 $2.02 56-61 62-67 $2.19 $2.36 26-27 28-30 $2.19 $2.36 68-73 $2.53 31-33 $2.53 74-79 $2.70 34-36 $2.70 80-100 Ship Bulk Rate 37 and above Ship Bulk Rate Quantity Postage Quantity Postage Form No. A Description Claimant's Application for Change of Physician and Request for Hearing Form No. 10M 13 14 Description Response to Request for Payment of Charges for Medical or Rehabilitation Services Request for Prehearing Conference. Agreement Between Employer and Employee as to Fact with Relation to an Injury and Payment of Compensation (For injuries occurring before 7/1/05) Disclosure Statement Request For Administrative Review of Disputed Medical Charges Request for Payment of Charges for Medical or Rehabilitation Services/ Notice of Appeal of Administrative Order Proof of Loss For Spouse and Children Memorandum of Agreement as to Fact with Relation to an injury and Payment of Disability Compensation. (For injuries occurring after 6/30/05) Application and Order for Leave to Withdraw as Attorney of Record Pauper's Affidavit Claimant's Application and Order for Dismissal Application for Physicians Seeking Appointment as an Independent Medical Examiner Application for Medical Case Manager Application for Vocational Rehabilitation Evaluator Joint Petition Certificate of Joint Petition A-ORDER Order for Change of Treating Physician 1A 1A Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees A Viso E Instrucciones Para Todas Los Empleados Y Empleadores Sombre La Compensacion Para Los Trabajadores De Oklahoma Employer's Application for Permission to Carry Its Own Risk Without Insurance (Three Page Form) Compromise Settlement Certificate To Settle By Compromise Settlement Employer's First Notice of Injury Employee's First Notice of Accidental injury and Claim for Compensation Claimant's First Notice of Death and Claim for Compensation Employee's First Notice of Occupational Disease and Claim for Compensation Employee's Claim for Benefits for Combined Disabilities Against the Last Employer Employee's Claim for Benefits From Multiple Injury Trust Fund Treating Physician's Report and Notice of Treatment Treating Physician's Progress Report Physician's Report on Release and Restrictions Designation of Service Agent Motion to Set for Trial Answer and Pretrial Stipulation Offered by Respondent Respondent's Response to Claimant's FORM-A Application For Change Of Physician 17 18 19 1B 1X CCS 2 3 3A 3B 3E 3F 4 4A 5 7 9 10 10A 20 26 93 99 100 463 626 862 JP CJP American LegalNet, Inc. www.FormsWorkFlow.com
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