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Filing a claim - Applicable forms

Normally for workers' compensation claims, injured workers use the C-101 to ask providers to release medical information. However, sometimes providers, due to HIPPA concerns, will require a provider's proprietary medical release form. To address this potential issue, we're making Medicaid's medical release form available for download.
Note: Before you begin, download the instructions.​​​​​​​ 

Temporary total/Salary continuation - Applicable forms

Wage loss - Applicable forms

Scheduled loss - Applicable forms

Percentage of permanent partial - Applicable forms

Permanent total disability (PTD)/DWRF - Applicable forms

Lump sum settlement - Applicable forms

Lump sum advancement - Applicable forms

Wages - Applicable forms

Travel reimbursement - Applicable forms

Other - Applicable forms

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