Physician’s Initial Report of Work Injury or Occupational Disease Forms
| Form Name | Physician’s Initial Report of Work Injury or Occupational Disease |
| Form # | Form 123 |
| Form Revision | Rev 7/2024 |
| Category | Forms » First Report |
| Downloads | |
| Form State | Utah |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |