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Oklahoma CC-Form-5: Release and Restrictions Report

In Oklahoma workers' compensation claims, the treating physician uses this report to state the claimant's work status: released to regular duty, released to modified work, or still temporarily totally disabled. The report spells out the specific restrictions that apply and says whether the claimant needs continuing medical maintenance or vocational rehabilitation. Copies go to the claimant and every other party of record in the claim.

Who completes it

The treating physician completes the whole form, Sections I through III, and signs the certification made under penalty of perjury. The claimant and employer do not complete a section.

Submitting and payment

How to submit it
The physician sends copies of the completed report to the employee or claimant and to all other parties of record in the claim.

Good to know

  • The report separates three outcomes: release to regular work, release to modified work with specific restrictions, or continued temporary total disability.
  • When the claimant is released to modified work, the form calls for the specific restrictions that apply rather than only a release date.
  • Beyond work status, the physician addresses whether the claimant needs continuing medical maintenance and whether vocational rehabilitation is needed.
  • Related Commission forms include CC-Form 3, the employee's first notice of claim, and CC-Form A, the claimant's application for a change of physician.

Get the official form

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

Physician's Report on Release and Restrictions

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.

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Frequently asked questions

Who receives a copy of Oklahoma CC-Form-5?

Copies go to the employee or claimant and to all other parties of record in the claim. Because the report records the claimant's release status and restrictions, each party receives the same statement of work status and ongoing care needs directly from the treating physician.

Is CC-Form-5 signed under penalty of perjury?

Yes. The physician signs a certification made under penalty of perjury after completing Sections I through III. Because the statements are sworn in this way, the work status, restrictions and recommendations for ongoing care should match the physician's own examination findings and records.

What is the difference between CC-Form-5 and CC-Form-3?

CC-Form 3 is the employee's first notice of claim for compensation, filed to start a claim. CC-Form-5 comes later and is completed by the treating physician to report release to work, restrictions, temporary total disability and needs for medical maintenance or vocational rehabilitation.