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   Referal Forms
& Documents

We typically request the below claim file documents (if available) to create our file:

  • C-3

  • Job Description

  • FCE Report

  • Perm Restricts/Final PR

  • Wage Calculation Form

  • PPD Rating or Date of PPD Evaluation

  • Name of Attorney (if rep’d)

  • IME Reports

  • Initial Consultative Medical Report

Our referral forms can be downloaded if interested in using them.

For any questions email us at: admin@rvalv.com

Printable 
Version

Fillable 
Version

Printable 
Version

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