Initial Notice Direct Contracting Packet

Treating Doctor Selection Form

Referral to Provider not Contracted with the Alliance

Change of Treating Doctor Form

Resolution to Add Optional Workers' Compensation Coverage (Sample)

Notice 6 Notice to Employees Concerning Workers' Compensation in Texas
(must be posted for employees to read) (Rev. 10/05)

Aviso 6S (Spanish) Aviso a Empleados Sobre Compensación para Trabajadores en Tejas (Rev. 10/06)

Notice 8 Required Workers' Compensation Coverage
(building or construction projects for governmental entities) (Rev. 10/05)

Aviso 8S (Spanish) Cobertura Requerida de Compensación para Trabajadores (Rev. 1/06)

Notice 9 Notice Regarding Certain Work-Related Communicable Diseases and Eligibility for Workers' Compensation Benefits
(law enforcement officers, fire fighters, emergency medical service employees, paramedics, and correctional officers) (Rev. 10/05)

Aviso 9S (Spanish) Aviso Referente a Ceirtas Enfermedades Contagiosas Relacionadas con el Trabajo y la Eligibilidad para Beneficios Obtener Beneficios de Compensación para Trabajadores
(Policías, Bomberos, Empleados del Servicio de Ambulancia Paramédicos, y Oficiales del Departamento de Correccionales(Rev. 10/06)

DWC FORM-001 Employer's First Report of Injury or Illness (Rev. 10/05)

DWC FORM-156 Prospective Employment Authorization and Certification
(Rev. 10/05)

DWC FORM-002 Employer's Report for Reimbursement of Voluntary Payment (Rev. 10/05)

DWC FORM-003 Employer's Wage Statement (Rev. 10/05)

DWC FORM-004 Employer's Contest of Compensability (Rev. 11/08)

DWC FORM-5 Employer Notice of No Coverage or Termination of Coverage
(Rev. 10/05)

DWC FORM-6 Supplemental Report of Injury (Rev. 10/05)

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