Treating physicians on Alaska workers' compensation claims use this single form for the initial report, progress reports and treatment plans. It records findings, diagnosis, whether the condition is work related, medical stability and its date, any permanent impairment rating and release to regular or modified work. The original goes to the employer within 14 days of each treatment.
For initial and treatment plan reports the employee completes Sections 1 and 2 and the physician completes Sections 3 and 4. For progress reports the physician completes items 1, 3, 6, 7, 8 and 9 of Section 1, plus Section 4.
Download the current version from the source each time; forms change without notice.
Physician's Report
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.
Only when you treat the injured worker more often than the Board's chart allows: 3 treatments a week in the first month, 2 a week in months 2 and 3, 1 a week in months 4 and 5, and 1 a month from month 6 through 12. The plan states objectives, modalities, frequency and reasons.
Within 14 days after each treatment, the original goes to the employer. If you see the employee more often than every 14 days, all treatments in a 14-day period can be reported on one form. Late or incomplete reports can delay the employee's compensation.
Yes, on initial and treatment plan reports. The employee completes Section 1 (identification, employer and insurer) and Section 2 (how the injury happened, other doctors, hospitalization and complaints). The physician completes findings, diagnosis, work-relatedness, stability, impairment and release in Sections 3 and 4.