Oregon's Form 827 is the multipurpose medical report in workers' compensation claims. With the worker's section completed, it serves as a first report of injury or disease, a new or omitted condition request, a change of attending physician or an aggravation claim; without it, the provider files progress or closing reports or palliative care requests. Most provider deadlines run 72 hours or five days from the visit.
The worker completes and signs the worker section only for the four claim-related filing reasons, and the treating provider completes the provider section, signs it and attaches chart notes. Nurse practitioners, physician associates, chiropractic and naturopathic physicians must first certify with the Workers' Compensation Division.
The first page tells the provider which filing reasons need the worker's section (first report, new or omitted condition, aggravation, change of attending physician) and which do not (progress report, closing report, palliative care request). It defines aggravation as actual worsening of a compensable condition, explains that being primarily responsible excludes emergency, on-call, consulting, specialist and insurer-requested exams, and lists what a palliative care request must include.
Enter the worker's legal name, street and mailing address, language preference, phone, date of birth and occupation, the employer at the time of the original injury, the claim number if known, the date and time of the original injury, the last date worked, the health insurer and the workers' compensation insurer's name and address. WCD's online Employer Index can identify the insurer.
The worker checks one reason: first report of injury or disease, with whether the same body part was injured before; request for acceptance of a new or omitted condition, naming it; notice of change of attending physician, with the reason; or report of aggravation. The worker describes the accident, notes more than one job, and signs, which authorizes release of relevant medical records.
This block repeats the deadline for each worker-initiated report and requires chart notes explaining causation for a new or omitted condition. Signing for a change of attending physician accepts responsibility for the worker's care, and a box asks the insurer to send its records. For a progress report, closing report or palliative care request, check the matching box; a palliative request needs an attached care plan.
Enter the date and time of first treatment, last date treated, whether the worker was hospitalized as an inpatient and where, the next appointment, estimated length of further treatment, and the current diagnosis by ICD-10-CM code. Answer whether the injury caused permanent impairment (yes, no, expected or unknown) and whether the worker is medically stationary, with the date or anticipated date, attaching any impairment findings.
Authorize regular work (the job at injury) from a start date, modified work from a date through an end date if known, or no work from a date through an end date. The worker notice explains why this matters: time-loss payments start only after the provider notifies the insurer of inability to work, and continue only while the provider keeps verifying it.
Attach chart notes that describe symptoms, objective findings, type of treatment, lab and X-ray results, impairment findings marked temporary or permanent, physical limitations, any palliative care plan with rendering provider, modalities, frequency and duration, the name and address of any physician the worker is referred to, surgery, and the history when the report is a closing report.
Print, type or stamp the provider's name, degree, address and phone, then sign and date. Send the original and one copy to the insurer and keep a copy. For an initial claim, new or omitted condition, aggravation or change of attending physician, give copies plus Form 3283, the worker guide printed with the form, to the worker immediately.
Download the current version from the source each time; forms change without notice.
Worker's and Health Care Provider's Report for Workers' Compensation Claims
Reporte del Trabajador y del Proveedor Médico para Reclamaciones de Compensación para Trabajadores
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.
Sources for this guide
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For a first report of injury or illness, send it to the insurer within 72 hours of the visit. New or omitted condition requests and aggravation reports are due within five days of the visit, and a change of attending physician within five days of the change or first treatment. Closing exam reports go within 14 days of the medically stationary exam.
No. The note to providers says to ask the worker to complete the form only for the four filing reasons in the worker's section: first report, new or omitted condition, change of attending physician and aggravation. The worker does not complete or sign it for a progress report, closing report or palliative care request.
Yes. The Workers' Compensation Division publishes a Spanish version, Form 827s, titled Reporte del Trabajador y del Proveedor Médico para Reclamaciones de Compensación para Trabajadores, alongside the English PDF and a Word version. The worker notice on the English form also gives the division contact lines in Spanish.
Medical and osteopathic doctors, oral and maxillofacial surgeons, podiatric physicians, physician associates and authorized nurse practitioners are Type A attending physicians. Chiropractic and naturopathic physicians are Type B, with time and visit limits. Nurse practitioners, physician associates, chiropractors and naturopaths must certify with the division before the insurer has to pay them.