New Hampshire Code of Administrative Rules
Lab - Commissioner, Department of Labor
Chapter Lab 500 - WORKERS' COMPENSATION CLAIMS
Part Lab 508 - RESPONSIBILITIES OF TREATING PRACTITIONERS
Section Lab 508.01 - Medical Reports

(a) A "Workers' Compensation Initial Medical Report,", form 75WCA-1 (6/1994), contained in Appendix II, shall be completed in full and filed with the carrier within 10 days of the first examination. The health care provider shall keep a supply of the initial medical report form in their offices for completion. If an injured employee is released to return to work, the medical report form shall indicate whether the employee can resume his or her former duties or perform light or other work.

(b) There shall be no reimbursement for services rendered upon the failure of the practitioner to provide the carrier with the "Workers Compensation Initial Medical Report", 75WCA-1(6/1994), contained in Appendix II within 10 days of the first treatment. Furthermore, the failure of practitioner to provide the carrier with medical information necessary in the prompt processing of a claim, may result in the nonpayment of the medical bill under RSA 281-A:23V(c).

(c) Medical reports submitted in conjunction with assessment of permanent bodily loss under RSA 281-A:32 shall contain affirmation that the findings were determined from Guide to the Evaluation of Permanent Impairment, 5th edition, published by the American Medical Association available as noted in appendix III.