Texas treating and referral doctors use this report to tell the insurance carrier, employer and injured employee whether the worker can return to work without restrictions, with listed restrictions, or not at all, and for how long. It is required after the initial exam and whenever work status or restrictions substantially change. Employers can base a modified duty offer on the restrictions it lists.
The treating or referral doctor completes Parts I to IV, or a physician assistant or APRN with delegated authority, for whom the delegating doctor remains responsible. Designated doctors and required medical examination doctors also file it after exams that address work status, and the injured employee signs at the visit.
Boxes 1 to 12 identify the injured employee (name, injury date, last four SSN digits, description of the injury), the doctor or delegating doctor with degree (5a) and any PA or APRN completing the form (5b), the facility name, phone, fax and address, the employer and carrier, and the employer's and carrier's fax or email if known. Rule 129.5 counts this claim information among the minimum contents of a complete report.
Box 13 offers three choices; fully complete one, with estimated dates. 13a: return to work without restrictions as of a date. 13b: return with the Part III restrictions as of a date, expected to last through a date. 13c: the injury has prevented and still prevents return as of a date, expected through a date, with a description of how it prevents work. Expected end dates are not binding and can change on later reports.
Complete only if box 13b is checked. Boxes 14 to 20 cover posture and motion limits in maximum hours per day, restrictions specific to body parts, environmental limits, lift and carry limits in pounds and hours, miscellaneous items such as breaks, splints, crutches, driving and dressing changes, and medication effects such as drowsiness. Each box is marked 'if any', so leave inapplicable ones blank.
Record the work injury diagnosis (box 21), the date and time of the visit, the visit type (initial, follow-up or discharge) and expected follow-up services (box 22): the next treating doctor evaluation, referrals, physical medicine frequency, special studies, or none if this is the last visit. The employee signs, and the practitioner signs with license number and checks a role, such as treating, referral, designated or RME doctor, PA or APRN.
The second page is a filing chart by doctor type, showing when to file, who receives it, the delivery method and the deadline. Treating and referral doctors and delegated PAs or APRNs deliver to the employee at the exam and to the carrier and employer within 2 working days; designated doctors file within 7 working days with a narrative report, and RME doctors within 7 days.
Download the current version from the source each time; forms change without notice.
Texas Workers' Compensation Work Status Report
Reporte de Estado de Trabajo
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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After the initial examination regardless of work status, when work status or activity restrictions substantially change, on a carrier-requested schedule tied to appointments (no more than one every two weeks), and within seven days of receiving functional job descriptions or an RME doctor's DWC073 releasing the employee. Designated and RME doctors have their own triggers.
Yes, if the treating doctor delegates the authority and their licensing act allows it, a physician assistant or advanced practice registered nurse may complete, sign and file the DWC073. The delegating doctor's name goes in box 5a and the PA or APRN in box 5b, and the treating doctor remains responsible for their acts.
Use CPT 99080 with modifier 73 for a required report, add RR for an additional report the carrier requests on a schedule, and EC for an extra copy of a report already filed. The carrier must reimburse a complete required report, but one completed as a component of an ordered examination cannot be billed separately.
Yes. TDI publishes DWC073s, Reporte de Estado de Trabajo, on the same medical forms page as the English version, both at revision 09/19. The English form also opens with a bilingual notice telling the employee to report the injury to the employer within 30 days and that free help from DWC is available.