Chapter 4.5. Division of Workers' Compensation
Subchapter 1.6. Permanent Disability Rating Determination

§10161. Forms.

(a) Employee's Disability Questionnaire (DEU Form 100) (revised 4/05).

(b) Request for Summary Determination of Qualified Medical Evaluator's Report (DEU Form 101) (revised 4/05).

(c) Request for Summary Determination of Primary Treating Physician's Report (DEU Form 102)

(a) Employee's Permanent Disability Questionnaire (DEU Form 100) (revised 1/95). (.pdf format, 10K)

(b) Request for Summary Determination of Qualified or Agreed Medical Examiner's Report (DEU Form 101) (revised 1/95). (.pdf format, 8K)

(c) Request for Summary Determination of Primary Treating Physician's Report (DEU Form 102). (.pdf format, 8K)

NOTE

Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 124, 4061, 4062, 4062.01, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.

HISTORY

1. New section filed 4-25-91; operative 4-25-91 (Register 91, No. 26). New section is exempt from review by OAL pursuant to Government Code section 11351.

2. Repealer and new DEU Form 100 filed 1-28-94; operative 1-28-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 94, No. 4).

3. Editorial correction restoring inadvertently omitted subsection (b) (Register 95, No. 8).

4. Amendment of subsections (a), (b) and forms 100 and 101; and new subsection (c) and form 102 filed 2-21-95; operative 2-21-95. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 95, No. 8).

5. Certificate of Compliance as to 12-31-2004 order, including further amendment of section and forms and amendment of Note, transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register 2005, No. 23).