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ARIZONA FORMS & PROVIDER LIST

Click on the links below to access some of the most commonly used forms.

Contact Info:
Julie Mulder
P.O. Box 140577
Boise, ID 83714
Office: (208) 996-2017
Fax: (208) 853-4076

Worker's & Physician's Report of Injury

Employer's Report of Industrial Injury

Worker's Report of Injury

Arizona Provider List

Industrial Solutions Provider List

Job Analysis - Full Duty*

 

Job Analysis - Light Duty*

Form A*

Form B*

Form C*

Form D*

Form E*

 

Fill the forms out completely, sign and fax to us at (208) 853-4076

 

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