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What Reports are Required in Utah for Medical Providers?

28 Jan, 2025 Frank Ferreri

                               
Do You Know the Rule?

When medical bills are at issue in Utah, the state requires reports. Simply Research subscribers have access to those rules, and we highlight the requirements here.

Physician's Initial Report of Work Injury or Occupational Disease - Form 123. Within one week after providing initial medical care to an injured worker, a health care provider shall complete "Form 123 - Physicians' Initial Report." The provider shall fully complete Form 123 according to its instructions. The provider shall then file Form 123 with the Division and payor.

1. Form 123 must be completed and filed for every initial visit for which a bill is generated, including first aid, when the worker reports that his or her medical condition is work related.

2. If initial medical care is provided by any health care provider other than a physician, Form 123 must be countersigned by the supervising physician.

Form 221, Restorative Services Authorization. Form 221, "Restorative Services Authorization Form" required by Subsection R612-300-5. C. 7. shall be filed with both the payor and the Division.

Forms 043, Attending Physician's Statement, and Form 044, Employee's Notification of Intent to Leave Locality or State and to Change Doctor or Hospital. These forms are to be submitted to the Division before an injured worker leaves Utah.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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