A Nevada treating chiropractor uses Form D-32 to ask the workers' compensation insurer for chiropractic treatments beyond those already authorized. The request gives the number of treatments since the first visit, the present condition with objective findings, symptoms and complaints, the number and type of further treatments, whether the worker can work now, an expected return-to-work date, and when treatment will be completed if approved.
The treating chiropractic physician (D.C.) completes everything above the 'For Insurer's Action' box and signs with address and telephone. The insurer completes the bottom box, granting or denying authorization or noting other action, with date, signature and title.
Download the current version from the source each time; forms change without notice.
Authorization Request for Additional Chiropractic Treatment
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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When a treating chiropractor wants to provide more chiropractic treatments on a Nevada workers' compensation claim than the insurer has already approved. The D-32 asks the insurer to authorize a defined number of additional treatments and records the insurer's grant, denial or other action at the bottom.
It asks whether the injured employee is capable of working now, yes or no, with a date. If not, the chiropractor estimates the date the employee will be able to return to work, and separately gives the date treatment will be completed if the additional visits are authorized.
No. The D-32 on the Division's forms page is a flat, one-page PDF dated 7/99 without fillable fields, and it instructs the chiropractor to type or print and provide all information requested. The insurer completes its action box on the same page.