The following table contains the most current version of
the Court's forms. The previous version of a particular form is available
from the Court's Records Department, 1915 N. Stiles Avenue, Oklahoma City, OK
73105-4918, upon written request therefor.
|
Form No. |
Title |
Mandatory
Form Color |
File |
|
|
Instructions for the use of PDF forms on OSCN. |
|
HTML |
|
1A |
Oklahoma Workers' Compensation Notice and Instruction to Employers and
Employees. 7/05 |
Peach |
PDF |
|
1A |
A
Viso E Instrucciones Para Todos Los Empleados Y Empleadores Sobre La
Compensacion Para Los Trabajadores De Oklahoma. 08/05 |
Tan |
PDF |
|
1B |
Employer's Application for Permission to Carry Its Own Risk Without
Insurance. 07/07 (three page form) |
|
PDF |
|
1X |
Compromise Settlement. 2/06 |
|
PDF |
|
CCS |
Certificate to Settle by Compromise Settlement. 7/05 |
|
PDF |
|
2 |
Employer's First Notice of Injury. 2/06 |
|
PDF |
|
3 |
Employee's First Notice of Accidental Injury and Claim for Compensation.
2/06 |
Yellow |
PDF |
|
3A |
Claimant's First Notice of Death and Claim for Compensation.
2/06 |
Gold |
PDF |
|
3B |
Employee's First Notice of Occupational Disease and Claim for Compensation.
2/06 |
Gray |
PDF |
|
3E
|
Employee's Claim for
Benefits for Combined Disabilities Against the Last Employer
2/06 |
Turquoise
|
PDF |
|
3F |
Employee's Claim for Benefits From Multiple Injury Trust Fund. 2/06 |
Tan |
PDF |
|
4 |
Treating
Physician's Report and Notice of Treatment. 2/06 |
|
PDF |
|
4A |
Treating
Physician's Progress Report. 2/06 |
|
PDF |
|
5 |
Physician's Report on Release and Restrictions. 4/06 |
|
PDF |
|
7 |
Designation of Service Agent. 10/09 |
|
PDF |
|
9 |
Motion to Set for Trial. 3/08 |
|
PDF |
|
10 |
Answer and Pretrial Stipulation Offered by Respondent.
1/07 |
Green |
PDF |
|
10A |
Respondent's Response to Claimant's Form A Application For
Change of Physician. 2/06 |
Blue |
PDF |
|
10M |
Response to Request for Payment of Charges for Medical or Rehabilitation
Services. 2/06 |
Ivory |
PDF |
|
13 |
Request for Prehearing Conference. 3/08 |
|
PDF |
|
14 |
Agreement Between Employer and Employee as to Fact with Relation to an
Injury and Payment of Compensation. (For injuries occurring before 7/1/05)
2/06 |
|
PDF |
|
17 |
Disclosure Statement. 2/06 |
|
PDF |
|
18 |
Request For Administrative Review of Disputed Medical Charges.
2/06 |
Orchid |
PDF |
|
19 |
Request for Payment of Charges for Medical or Rehabilitation Services/
Notice of Appeal of Administrative Order.
2/06 |
|
PDF |
|
20 |
Proof
of Loss for Spouse and Children.
2/06 |
Blue |
PDF |
|
26 |
Memorandum of Agreement as
to Fact with Relation to an Injury and Payment of Disability Compensation.
(For injuries occurring after 6/30/05) 2/06 |
|
PDF |
|
93 |
Application and Order for Leave to Withdraw as Attorney of Record. 2/06 |
|
PDF |
|
99 |
Pauper's Affidavit. 2/06
(two-sided form) |
|
PDF |
|
100 |
Claimant's Application and Order for Dismissal.
2/06 |
|
PDF |
|
463 |
Application for Physicians Seeking Appointment as an Independent Medical
Examiner. 2/06 |
|
PDF |
|
626 |
Application for Medical Case Manager 2/06 |
|
PDF |
|
862 |
Application for Vocational Rehabilitation Evaluator.
11/01 |
|
PDF |
|
A |
Claimant's Application for
Change of Physician and Request for Hearing. 2/06 |
|
PDF |
|
A - Order |
Order for Change of Treating Physician. 5/06 |
|
PDF |
|
JP |
Joint
Petition. 3/08 |
|
PDF |
|
CJP |
Certificate to Joint Petition. 2/06 |
|
PDF |
|
926 |
Mediator Application |
|
PDF |
|
|
Appointment of Independent Physician or Rehabilitation Evaluator. 08/02 |
|
PDF |
|
|
Copy
Request Form. 2/06 |
|
PDF |
|
|
Vendor Maintenance Form
10/03 |
|
PDF |
|
|
Request for Court Forms 5/08 |
|
PDF |
|
|
Request for Independent Medical Examiner, Rehabilitation
Evaluator or Medical Case Manager |
|
PDF |
|
|
Prior Claims Request Form 2/06 |
|
PDF |
