Oregon Workers' Compensation Division forms for treating providers, from the Form 827 first report to the range of motion forms used at closing exams.
Oregon's Workers' Compensation Division (WCD), part of the Department of Consumer and Business Services, publishes the forms attending providers use on Oregon claims. The one you meet first is Form 827, the Worker's and Health Care Provider's Report. It serves as the first report of injury or disease, an aggravation claim, a new or omitted condition request, a change of attending physician or NP, and progress and closing reports. Form 3245 records return-to-work status, and Form 5425 gives notice of elective surgery.
Send Form 827 to the insurer within 72 hours of the first visit and give the worker a copy. Nurse practitioners, physician associates, chiropractors and naturopaths must first file a WCD certification statement to act as attending provider. At the closing exam, the attending physician or a medical arbiter records measurements on the range of motion forms and on Form 2312 for vision. Form 827 also comes in Spanish, and most forms have a Word version. Vero Documents fills PDF forms from the visit note and the chart.
Reporte del Trabajador y del Proveedor Médico para Reclamaciones de Compensación para Trabajadores
Multi-purpose report: first report of injury or disease, aggravation claim, new/omitted condition request, change of attending physician/NP, progress and closing reports, and palliative care requests.
Physician's notice of the worker's work status (regular work, modified work with restrictions, or not released) and physical capacities.
Provider's notice to the insurer of a proposed elective surgery so the insurer can request a consultation (second opinion).
Records cervical spine range of motion for permanent impairment rating.
Records lumbar spine range of motion for permanent impairment rating.
Records thoracic spine range of motion for permanent impairment rating.
Records elbow, wrist and digit range of motion, sensation loss and amputation for impairment rating.
Records visual acuity, field deficits, ocular motility, lacrimal and other ocular impairments for rating.
Notifies the worker of invasive procedures planned in an independent medical examination and records consent or refusal.
Insurer's response on whether a consultation exam is scheduled; the physician may use it to notify the insurer, worker and attorney of agreement with the consultation.
Physician authorizes supplemental disability (wage replacement for secondary jobs) beyond temporary disability for the primary job.
Records lower extremity range of motion for impairment rating.
Records shoulder range of motion for impairment rating.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The provider sends Form 827 to the insurer within 72 hours of the first visit, or with the report, and gives the worker a copy. The same form covers a first report of injury or disease, an aggravation claim, a new or omitted condition, a change of attending physician or NP, progress and closing reports, and palliative care requests. For a claim or change request, the worker completes the worker section.
The attending physician or an authorized nurse practitioner. Form 3245, Return-to-Work Status, states whether the worker is released to regular work, released to modified work with restrictions, or not released, and it records physical capacities. Return it to the insurer or the employer. WCD publishes it as a fillable PDF and as a Word document.
At the closing or impairment exam, the attending physician or a medical arbiter records measurements under OAR 436-035 standards. WCD has range of motion forms for the cervical (2278c), lumbar (2278L) and thoracic (2278T) spine, the upper extremity (2279), the lower extremity (4841) and the shoulder (4842), plus Form 2312 for visual impairment. Each one goes to the insurer or self-insured employer.
The ordering surgeon sends Form 5425, Elective Surgery Notification, to the insurer with supporting chart notes. Chart notes alone no longer count as notice. The notice lets the insurer request a consultation, or second opinion. The insurer answers on Form 3228, Elective Surgery Response, and the physician can use that form's response portion to agree with the consultation.