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Nevada Forms

73 State Forms found

name	number	revision	print or send online
PROOF OF COVERAGE NOTICE	D-48	(Rev 7/99)
REAFFIRMATION/RETRACTION OF LUMP SUM REQUEST	D-11	rev. 8/21
REHABILITATION LUMP SUM REQUEST	D-28	rev. 7/99
Request for Additional Medical Information and Medical Release	D-36	(Rev. 11/23)
REQUEST FOR HEARING - CONTESTED CLAIM	D-12a	(Rev. 10/2018)
REQUEST FOR HEARING - UNINSURED EMPLOYER	D-12b	(Rev. 07/25)
REQUEST FOR REIMBURSEMENT OF EXPENSES FOR TRAVEL AND LOST WAGES	D-24	rev. 6/2006
SOLE PROPRIETOR COVERAGE	D-45	(Rev. 02/04)
Temporary Partial Disability Calculation Worksheet	D-46	(7/99)
WAGE CALCULATION FORM FOR CLAIMS AGENT'S USE	D-5	(rev. 7/99)
Request For Assignment of Rotating Physician Or Chiropractic Physician	D-35	(Rev 10/24)
TPA Information Form	No Form Number	10/2015
Workers' Compensation Claims Activity Report	FY14	10/14
DISCONTINUED BY STATE, NO REPLACEMENT - PERMANENT TOTAL DISABILITY CLAIMS – NRS 616C.453	NRS 616C.453 - DEACTIVATED	7/18
FY16 WCS Workers' Compensation Claims Activity Report	FY16	rev. 01/17

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Disclaimer: These forms may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.

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