Request For Authorization For Medical Treatment {DWC RFA}

DWC Form RFA - REQUEST FOR AUTHORIZATION. This form is required for the employee’s treating physician to initiate the utilization review process required by Labor Code section 4610. A Doctor’s First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating Physician’s Progress Report, DWC Form PR-2, or equivalent narrative report substantiating the requested treatment must be attached. The DWC Form RFA is not a separately reimbursable report under the Official Medical Fee Schedule, found at California Code of Regulations, title 8, section 9789.10 et seq. www.FormsWorkflow.com