1. A. A physician shall complete and file with the Commission a physician’s initial report of injury under A.R.S. § 23-908(A) within eight days after first providing treatment to an injured worker. The physician shall report the injury:

   1. 1. Using the Worker’s and Physician’s Report of Injury, or
   2. 2. Attaching a medical report that contains the information required in the Worker’s and Physician’s Report of Injury.
2. B. The physician shall sign and date the Worker’s and Physician’s Report of Injury or the medical report. The signature of the physician may be typewritten or stamped on this form.
3. C. If a claimant uses the Worker’s and Physician’s Report of Injury to initiate a claim, either the injured worker or the injured worker’s authorized representative shall sign the worker’s portion of the Worker’s and Physician’s Report of Injury.

Historical Note

Former Rule 11. Amended effective March 1, 1987, filed February 26, 1987 (Supp. 87-1). R20-5-111 recodified from R4-13-111 (Supp. 95-1). Section R20-5-111 renumbered to R20-5-110; new Section R20-5-111 renumbered from R20-5-112 and amended by final rulemaking at 31 A.A.R. 4199 (October 31, 2025), effective December 6, 2025 (Supp. 25-4).