Forms/Laws

Utah Forms

Change State
Select Report Type  
 

 92 State Forms found

name number revision print or send online

AUTHORIZATION TO DISCLOSE, RELEASE AND USE PROTECTED HEALTH INFORMATION (10 YEARS OF RECORDS) HIPAA COMPLIANT

 Form 308 6.12.2020

AUTHORIZATION TO RELEASE INDUSTRIAL ACCIDENT DIVISION RECORDS

 Form 205 Revised 3/2020

COMMUTATION AGREEMENT

 No Form Number No Form/Rev Date

COMPROMISE AGREEMENT

 No Form Number No Form/Rev Date

(DISCONTINUED BY STATE, NO REPLACEMENT) DEPENDENT'S BENEFIT INFORMATION

 Form 151 - DEACTIVATED Revised 2/09

Emergency Medical Service Provider Exposure Report Form

Form 350 Revised 8/2024

EMPLOYEE NOTIFICATION OF DENIAL OF CLAIM

 Official Form 089 Rev 12/2025

EMPLOYEE'S NOTIFICATION OF INTENT TO LEAVE LOCALITY OR STATE, AND TO CHANGE DOCTOR OR HOSPITAL

 Form 044 Rev 10/2019

GRAMA Document Request Form

 No Form Number Revised 03/06/2012

STATEMENT OF BENEFITS PAID

 Official Form 141 Revised 6/2025

NOTICE OF FURTHER INVESTIGATION OF WORKERS’ COMPENSATION CLAIM

 Official Form 441 Revised 7/2024

FINAL REPORT OF INJURY AND STATEMENT OF TOTAL LOSSES

 Official Form 130 Revised 7/2024

(DISCONTINUED BY STATE, NO REPLACEMENT) Insurer Request for Extension of Time to Obtain 2nd Dental Opinion

 Form 198 - DEACTIVATED Revised 10/14

(DISCONTINUED BY STATE) Insurer / Employer Initial Reemployment Report for Injured Worker

 Form 206 - DEACTIVATED This form is no longer available

REQUEST FOR MEDICAL RECORDS

 Form 302 Rev 8/2025
Disclaimer: These forms may not be the most recent version. Utah 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.
Loading results ...
Origami Risk
1379 N 1075 W, Suite 226,
Farmington, UT 84025
312.546.6515
info@origamirisk.com
© 2026 Origami Risk. All Rights Reserved.