Freeman Rehabilitation Services
Debbie Freeman
P.O. Box 370, San Carlos CA 94070
Phone: 650-595-4447 ~ Fax:
866-804-0574
dfreeman@freemanrehabilitationservices.com
Physician’s Return-to-Work
& Voucher report
- For dates of injuries post 1/1/13
physicians are required to complete a Physician’s Return-to-Work &
Voucher Report (DWC AD Form 10133.36) once the injured worker is permanent
and stationary from all conditions and the injury has caused permanent
partial disability.
- FRS prepares a cover letter and
fills in pertinent claim information on the Physician’s Return-to-Work
& Voucher Report (DWC AD Form 10133.36) and faxes over to the
physician in order to expedite a response. FRS will follow up with the
physician until a completed response has been received by all parties.
- When applicable, FRS will prepare
and attach a detailed regular, modified or alternative job description
(DWC AD Form 10133.33) to fax over with the Physician’s Return-to-Work
& Voucher Report (DWC AD Form 10133.36) to assist the physician in
making accurate assessments.