Treatment Information

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Opioid Information

Important resources including patient agreements, risk assessment, mental health screening tools, functional assessments and the Colorado Physician Drug Monitoring Program (PDMP).  Chronic Opioid treatment information can be found in the Chronic Pain Medical Treatment Guideline

Forms

Commonly used Division of Workers' Compensation Forms for Medical Providers:

  • Physician’s Report of Workers’ Compensation Injury: WC 164:  must be used at the opening and closing of case, and when a change of work restrictions occurs. The authorized treating physician must sign the WC 164 form even when the form is completed by an accredited or not accredited mid-level provider.
  • Pre-authorization Form/WC 188: this form is required when the treatment falls outside the medical treatment guidelines. If the treatment is within the guidelines, use the WC 195 form as explained below.
  • Notification by an Authorized Treating Provider/WC 195: providers may submit this form when the treatment is medically necessary, is consistent with the Medical Treatment Guidelines and has an established value under the Medical Fee Schedule. If the insurer does not respond within 5 days, payment for treatment is ensured.
  • Medical Dispute Resolution/WC 181: if a dispute regarding billing, payment or prior authorization arises, the provider may submit this form to the Division for resolution.
  • Discharge for Non-Medical Reasons/Desk Aid 15: If discharging a patient for non-medical reasons a certified letter must be sent to the patient and the insurer. This provides instructions for when to send a certified letter and also includes a templated letter that may be used. Patient Non-Compliance Information.