Try for free

Oregon WCD Form 3227: IME Invasive Procedure Consent

An Oregon independent medical examination (IME) physician who wants to perform an invasive procedure, one that breaks the skin or enters the body with a needle, tube, scope or scalpel, must give the worker this form first. The physician describes the proposed procedure, and the worker checks yes or no and signs. Refusing cannot suspend the worker's benefits, and the signed form becomes part of the IME record.

Who completes it

The IME physician completes the top section with the proposed procedure, exam date and signature. The worker completes the bottom section, consenting or declining, and signs it.

Submitting and payment

How to submit it
The physician gives the worker a copy, keeps one, and sends the original to the insurer; the IME report must include a copy of the signed form.
Who pays
The insurer or self-insured employer that requests the IME pays for it, and the IME provider bills using Oregon-specific code D0003.

Good to know

  • Before the procedure, the physician must explain its risks and tell the worker of the right to refuse, then hand over the form.
  • The worker sections and key statements are printed in both English and Spanish on the same form.
  • Failing to follow the invasive procedure rule can lead to sanctions against the provider under OAR 436-010-0340(1), according to WCD's IME training guide.
  • Only providers on the director's list of authorized IME providers perform IMEs, after completing WCD's training guide (4913), quiz and application.

Get the official form

Download the current version from the source each time; forms change without notice.

Invasive Medical Procedure Authorization

Official pagePDF

How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Can an injured worker in Oregon refuse an invasive procedure at an IME?

Yes. The worker has the right to refuse, and the form states that workers' compensation benefits cannot be suspended for saying no. The worker records the decision by checking yes or no on Form 3227 and signing it, and the physician gives the worker a copy.

What counts as an invasive procedure on Form 3227?

The form defines it as a procedure that breaks the skin or penetrates, pierces or enters the body using a surgical or exploratory procedure, for example by a needle, tube, scope or scalpel. A planned procedure of this kind needs the form before it is performed at the IME.