Download Forms

Click on the links below for easy access to the following forms:

Are you looking for the Pinnacol Online registration form? You can now register online.

Declaration of Independent Contractor Status
Declaration of Independent Contractor Status-Spanish
EDI (Electronic Billing) Registration (medical providers only)
First Report of Injury
First Report of Injury (Spanish) 
HCFA1500 Billing  (medical providers only)
SelectNet Medical Provider Designation
SelectNet Provider Nomination
UB92 Billing (medical providers only) 

Resource Materials Order Form

Division of Workers' Compensation Resources

Division of Workers' Compensation Resources Medical Treatment Information 

  • Treatment Guidelines 

Division of Workers' Compensation Resources Rules of Procedure

  • Rule 18 Medical Fee Schedule

  • Conversion Factors

  • Division-established Codes and Values

Division of Workers' Compensation Forms and Desk Aids

  • Medical Provider Forms and Desk Aids

  • WC164

  • Impairment Rating Desk Aid (includes IR Worksheet and Guidelines)

  • Apportionment Desk Aid

  • Controlled Substance Guidelines and Patient Contract

  • Pain Diagram

  • Functional Capacity Evaluation Supplement 

Department of Workers' Compensation Quick List

  • Accreditation Information
  • Utilization Management
  • Opioid Management Reference
  • Statutory References