If you are the first doctor to diagnose a worker for an occupational injury or disease, you are responsible for completing the Providers Initial Report (PIR) and providing a copy to the self-insured employer, Puget Sound Workers’ Compensation Trust (Trust).
The Provider’s responsible for fully completing the Providers Initial Report (PIR):
(1) Fill out the PIR form completely. Leaving blank areas may delay processing of the claim and your bills. If the condition is a disease, enter “N/A” for “not applicable” in both of the following boxes:
- Date of injury
- Time of injury
(2) Be as specific as possible.
- Include a complete diagnosis and appropriate Common Diagnostic Codes (ICD-10 codes). Clarify the specific body site and the definition of the injury.
- If your patient is unable to perform any work due to the injury or disease, estimate how much time the injured worker will lose due to the injury.
- The PIR must be signed by both you and your patient.
(3) Submit the PIR promptly with copies of the:
- History and Physical.
- Emergency room evaluation or your office notes.
