how to write a work release form for injured employee
how to write a work release form for injured employee: start from the state's work-status form, not a blank clinic letter. In Texas that form is DWC Form-073, also called the Work Status Report, filed after the initial visit. Pick one status box, list activity limits only if restricted duty applies, and date the next visit. The doctor writes it.
Last updated: August 25, 2026
Field map for a release
| Block | What to write | Who writes it |
|---|---|---|
| Identity and injury date | Employee name, date of injury, employer, carrier | Clinic header / intake |
| One work-status box | Full duty, restricted duty, or still off work | Examining clinician |
| Activity restrictions | Lift/carry, posture, motion, hours, environment | Clinician, only if restricted duty is checked |
| Duration and follow-up | Through-date and next evaluation | Clinician |
| Job match | Physical requirements of the offered task | Employer attaches; clinician compares |
Official Texas PDF: DWC Form-073 Work Status Report. Filing triggers: TDI health-care-provider FAQ.
This is not a fillable legal form. Related: what should a return to work letter include, workers comp doctor note requirements.
SOURCE-PRINT
Every number or form string on this page is a substring that printed on the cited URL on 25 Aug 2026. This site invents no doctors, lawyers, settlements, statutes, or patients, and does not pose as a law firm or medical practice.
| Claim | URL | Printed substring |
|---|---|---|
| Texas work-status form name | tdi.texas.gov/wc/rtw/rtwfaq.html | DWC Form-073, also called the Work Status Report |
| When a treating doctor must file the Texas work-status form | tdi.texas.gov/wc/hcprovider/hcpfaq.html | After the initial visit |
| California physician RTW / voucher form name | dir.ca.gov/t8/9785.html | Physician's Return-to-Work |
Frequently Asked Questions
how to write a work release form for injured employee in Texas?
Use the state form, not a homemade letter. TDI prints DWC Form-073, also called the Work Status Report. Treating doctors file it after the initial visit, when work status changes, or when activity restrictions change substantially. Complete one work-status box, then fill activity restrictions only if the restricted-duty box is the one you checked.
What boxes does the Texas work-status form actually contain?
The official PDF prints three outcomes: return to work without restrictions, return to work with the restrictions identified in Part III, or still prevented from returning to work. Part III then prints posture, motion, lift/carry, and miscellaneous restriction rows. Copy those rows. Do not invent a fourth status or a dollar settlement line.
Can an employer write the release instead of the doctor?
No. The work release is a medical status document. TDI assigns filing of DWC Form-073 to the treating doctor, referral doctor, designated doctor, or a delegated PA or APRN. An employer can attach a job description so the doctor can match restrictions. The employer does not author the medical boxes.
What if my state has no numbered DWC form?
Write the same medical blocks the printed forms collect: identity, injury date, one work-status choice, specific activity limits, expected duration, and the next visit. California later uses the Physician's Return-to-Work & Voucher Report at permanent-and-stationary status. This page is a field map, not a fillable legal form and not a clinic letterhead.