Georgia's State Board of Workers' Compensation requires the attending physician to report on an injured employee with this one-page form, marked initial, interim or final. It covers history, examination findings, diagnosis with ICD-10 code, treatment, prognosis, return-to-work dates and restrictions, maximum recovery and any permanent disability rating under the AMA Guides. It goes to the insurer, and the form warns that not submitting it jeopardizes payment of fees.
The authorized treating physician completes the whole form, including items 1 to 17, the itemized services table and the doctor's name, FEIN or SSN, address and signature. The employee and employer complete nothing; the insurer or self-insurer files it with the Board only when the rules require.
Check the box for the report being sent. Board Rule 61 calls for a report after initial treatment, at least every three months while treatment continues, at release to work, when a permanent partial disability rating is set, and at discharge, so the box tells the insurer which event the report covers. The banner warns that failure to submit the report to the insurer will jeopardize payment of fees.
Enter the Board claim number, the employee's name, date of injury, address and phone, the employer's name, phone and mailing address, the insurer or self-insurer's name and mailing address, and the claims office name, phone and location. These blocks let the insurer match the report to the claim and show where the three copies go.
Give the date disability began and the date of first treatment, then show who authorized your services in item 3: the employer, another doctor by name, or other. Record the patient history in item 4 and the findings from examination in item 5. Board Rule 205 ties payment to treatment prescribed by an authorized treating physician, which is why the authorization source matters.
Describe the diagnosis with its ICD-10 code, describe the treatment given, and state the prognosis. Under Board Rule 205, treatment is paid when it is related to the job injury and reasonably required to effect a cure, give relief, restore the employee to suitable employment, or establish whether the condition is causally related to the accident.
Enter the date of maximum recovery and your estimate of the length of disability, and note whether catastrophic case management is recommended (item 11). Then record the date the patient was discharged as cured, any date the patient stopped treatment without an order, and any date the patient refused treatment, since each affects the insurer's handling of benefits.
Give the date the patient can return to work without restrictions (15a) or with restrictions (15b), and list the restrictions (15c). A release to return to work is itself one of the events that calls for a WC-20a, and a release with restrictions starts the employer's 60-day window to send the employee Form WC-104.
Give the hospital's name if the patient was hospitalized. Item 17 asks whether the employee has any permanent disability; if yes, specify the part of the body and the percentage based on the AMA Guides. A report containing a permanent partial disability rating must be filed by the insurer with the Board within 10 days of receipt.
Itemize each service with the date of service, CPT or CDT code, the medical, surgical or dental service or drug, units and amount. Then enter the doctor's name, FEIN or SSN, address, date and signature. The form asks you to type it and file three copies with the insurer or self-insurer, along with office notes and narratives.
Download the current version from the source each time; forms change without notice.
Medical 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.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Board Rule 61 requires the report within seven days of initial treatment, upon the employee's discharge, at least every three months until discharge, upon release to return to work, when a permanent partial disability rating is determined, and when charges are submitted under Rule 203(b). Check Initial, Interim or Final at the top to show which report it is.
Usually not. The physician sends it to the employer or insurer. The insurer files medical reports with the Board within 10 days of receipt only when a report contains a permanent partial disability rating, when a rehabilitation plan is filed, when the Board requests them, or to comply with other Board rules.
No. Board Rule 205 lists the WC-20a, the 1500 claim form and any supporting narrative among the reports required by the Board and says they must be furnished at no charge to the party responsible for payment. The services itemized on the report are paid at the Board's fee schedule, normally within 30 days of the insurer receiving charges and reports.
Item 17 asks whether the employee has any permanent disability; if yes, specify the part of the body and give a percentage based on the AMA Guides. A report with a permanent partial disability rating is one of the triggers for sending a WC-20a, and the insurer must file it with the Board within 10 days of receipt.