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Forms & Resources

Return-To-Work Form
With every medical appointment, a doctor’s opinion regarding activity restrictions is required. Please take this form to your medical appointment and ask the office to fax it to 605-333-9835.
Return-to-Work Form (PDF)

Travel Log
Mileage may be allowable for your out-of-town travel. Contact your adjuster to see if you qualify! Then, log your trips and submit this form to your adjuster.
Travel Log (PDF)

Medical Authorization Form     
Please complete and sign this form allowing our office to have access to your medical records which document the claimed injury.
Medical Authorization Form-HIPAA (PDF)

First Report of Injury Form 
The First Report of Injury is required by the State of South Dakota when filing a workers’ compensation claim. The form is completed by the injured employee and their employer. The employer then submits the form to Claims Associates, who files it with the Department of Labor and Regulation. 
First Report of Injury Form 

South Dakota Department of Labor and Regulation
South Dakota Department of Labor, Division of Labor and Management, Workers Compensation 
South Dakota Codified Laws (SDCL) 
Administrative Rules of South Dakota (ARSD) 
South Dakota Unified Judicial System (SD Supreme and Circuit Courts)