Designated Doctor Certification Application {DWC-67}

DWC067 - DESIGNATED DOCTOR CERTIFICATION APPLICATION. Who can use this application? Doctors, including doctors of medicine, doctors of osteopathic medicine, doctors of chiropractic, doctors of dentistry, doctors of optometry and doctors of podiatry, may use this form to apply for or renew a designated doctor certification. When must I apply for renewal? A designated doctor who seeks to renew their certification immediately after their current term expires, without interruption, must apply for certification no later than 45 days before the end of the term. DWC will not assign exams during the last 45 days of an expiring term if we have not received all of the information required under 28 Texas Administrative Code Section 127.100(b)(1)-(9). www.FormsWorkflow.com