California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 7 - Department of Industrial Relations › Subchapter 1 - Occupational Injury or Illness Reports and Records › Article 1 - Reporting of Occupational Injury or Illness › Section 14003 - Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every
					 physician, as defined in Labor Code Section
					 3209.3, who
					 attends an injured employee shall file, within five days after initial
					 examination, a complete report of every occupational injury or occupational
					 illness to such employee, with the employer's insurer, or with the employer, if
					 self-insured. The injured or ill employee, if able to do so, shall complete a
					 portion of such report describing how the injury or illness occurred. Unless
					 the report is transmitted on computer input media, the physician shall file the
					 original signed report with the insurer or self-insured employer.
(b) If treatment is for pesticide poisoning
					 or for a condition suspected to be pesticide poisoning, the physician shall
					 also file a complete report directly with the Division within five days after
					 initial treatment. In no case shall treatment administered for pesticide
					 poisoning or suspected pesticide poisoning be deemed to be first aid
					 treatment.
(c) The reports required
					 by this Section shall be made on Form 5021, Rev. 5, Doctor's First Report of
					 Occupational Injury or Illness (sample forms may be secured from the Division),
					 upon a form reproduced in accordance with Section
					 14007, or by use of computer input
					 media prescribed by the Division and compatible with the Division's computer
					 equipment. However, reports may be submitted on Revision 4 of Form 5021 for
					 dates of service prior to October 1, 2015. Although ICD-10 coding is required
					 on or after October 1, 2015, for a twelve-month period ending October 1, 2016,
					 no medical treatment or medical-legal bill shall be denied based solely on an
					 error in the level of specificity of the ICD-10 diagnosis code(s) used.
					 Providers may use either version of the form until December 31, 2015. As of
					 January 1, 2016, providers must use the 2015 version of the form.
(d) Physicians who use computerized data
					 collection and reporting systems shall keep the injured worker's statement with
					 the patient's medical records.
1. New
						section filed 2-8-80; designated effective 5-1-80 (Register 80, No.
						6).
2. Amendment of subsection (c) filed 1-13-83; effective
						thirtieth day thereafter (Register 83, No. 3).
3. Amendment filed
						6-14-89; operative 7-14-89 (Register 89, No. 25).
4. Editorial
						correction of printing error in subsection (a) (Register 90, No.
						6).
5. Amendment of subsections (a) and (c) filed 1-14-93; operative
						2-16-93 (Register 93, No. 3).
6. Editional correct of printing error
						in subsection (c) (Register 93, No. 44).
7. Amendment of subsection
						(c) filed 9-21-2015; operative 10-1-2015 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2015, No. 39).
Note: Authority cited: Section
						  6410, Labor
						  Code. Reference: Sections
						  6409(a),
						  6409.3, and
						  6410, Labor
						  Code.