Form 223 – Authorization Request for Medical Procedures/Carrier Response
![Form 223 - Authorization Request for Medical Procedures/Carrier Response](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-223-Fillable.jpg)
Form 221c – Lower Extremity Restorative Services Authorization/Denial
![Form 221c - Lower Extremity Restorative Services Authorization/Denial](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-221c-Fillable.jpg)
Form 221b – Upper Extremity Restorative Services Authorization/Denial
![Form 221b - Upper Extremity Restorative Services Authorization/Denial](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-221b-Fillable.jpg)
Form 221a – Spine Injury Restorative Services Authorization/Denial
![Form 221a - Spine Injury Restorative Services Authorization/Denial](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-221a-Fillable.jpg)
Form 219 – Permanent Partial Disability Statement of Compensation
![Form 219 - Permanent Partial Disability Statement of Compensation](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-219-Fillable.jpg)
Form 123 – Physician’s Initial Report of Work Injury or Occupational Disease
![Form 123 - Physician's Initial Report of Work Injury or Occupational Disease](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-123-Fillable.jpg)
Form 102 – Application to Change Doctors
![Form 102 - Application to Change Doctors](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-102-Fillable.jpg)
Form 044 – Employee’s Notification of Intent to Leave Locality or State, and to Change Doctor or Hospital
![Form 044 - Employee's Notification of Intent to Leave Locality or State, and to Change Doctor or Hospital](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-044-Fillable.jpg)
Form 043 – Attending Physician’s Statement
![Form 043 - Attending Physician's Statement](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-043-Fillable.jpg)
Form 441 – Insurance Carriers/Self Insurer’s Notice of Further Investigation of a Workers’ Compensation Claim
![Form 441 - Insurance Carriers/Self Insurer's Notice of Further Investigation of a Workers' Compensation Claim](https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-441-Revised-2-2019.jpg)