Guides · Workers' compensation

Florida DWC-25 (DFS-F5-DWC-25): how to fill it out

By Kevin Lease, MD · Internal medicine · Published October 1, 2026

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If you treat injured workers in Florida, the DWC-25 lands on your desk after almost every visit. It is a two-page form, and it does more than report a work status. It is also how you ask the insurer to authorize treatment, and how you report maximum medical improvement and an impairment rating. Here is how I would go through it. The blank is on the Division of Workers' Compensation website (PDF), along with Florida's completion instructions, Form DFS-F5-DWC-25-A (PDF), which are worth reading once.

What the DWC-25 is

Florida's Division of Workers' Compensation says the provider completes the DWC-25 to request authorization for a treatment plan, to tell the carrier the injured employee's medical status, and to document the date of maximum medical improvement (MMI) and a permanent impairment rating. So one form does four jobs.

Florida's rule is strict about it being the one form. Rule 69L-7.730 says insurers and health care providers shall utilize only the Form DFS-F5-DWC-25 for physician reporting of the injured employee's treatment and status, and that no other reporting form may be used in place of it or added to it. The same rule says the DWC-25 does not replace your notes or medical records, and that what your notes say has to be consistent with what the form says. In practice that means I would write the note first and complete the form from it, rather than the other way round.

When it is due

The timing rows above come from Florida's completion instructions, which carry out rule 69L-7.730. The statute also asks for a complete report within 15 days after the first notice and progress reports if the employer or carrier asks for them, so if your office has a question about a particular deadline, the instructions and section 440.13 are the two places to read it in Florida's own words. Florida's instructions also say no reimbursement is made for completing the form, and the Division's provider FAQ says a carrier may refuse to pay for services when the DWC-25 that requested authorization for them was not submitted.

Who fills it in and who signs

Florida's instructions say the form is completed by all physicians who give direct billable services right after the injury, including physician assistants and advanced registered nurse practitioners (ARNPs) under the supervision of a physician, wherever they see the patient. An emergency physician completes a shorter set, items 1 to 8, 10, 11, 12, Section IV and the attestation. A physician who only reads a test, an anesthesia provider working with the operating surgeon, and an assistant surgeon do not have to complete it.

There are two signature blocks on page 2. The top one is the physician's, and next to the signature line it says I certify to any MMI / PIR information provided in this form. The lower one is for a provider other than a physician who gave billable services at that visit, such as a therapist. If only the physician gave services, Florida's instructions say to write N/A in it.

Two rules about MMI and the rating are worth knowing. The Division's page says only a physician can determine MMI or assign an impairment rating. And rule 69L-7.730 says a DWC-25 that reports restrictions, an impairment rating or an MMI date is signed by the physician who did the exam those things are based on. Florida's instructions also say an ink-stamped signature is not acceptable.

Section by section

The top of page 1, items 1 to 8. The insurer, the visit date, the patient's name and date of birth, the date of accident, the employer, and whether this is the patient's first visit with you. Item 5 is a box marked for insurer use only, so I leave it alone.

Section I, clinical assessment. Item 9 lets you say nothing in items 9 to 13 has changed since the last visit and skip ahead. Item 10 asks whether the injury is work related, not work related, or undetermined as of that date. Item 11 asks whether there are objective relevant medical findings, and the form prints Florida's rule right there, that pain or abnormal anatomical findings without objective relevant findings are not an indicator of injury and are not compensable. Item 12 is the diagnosis. Item 13 asks about major contributing cause, and the form explains that when there is more than one cause, the work injury has to contribute more than 50% to the present condition.

Section II, patient classification level. Level I is a specific, well-defined condition where the findings match the complaints. Level II is regional or generalized deconditioning. Level III is poor correlation between the complaints and the physical findings. There is also a box for undetermined as of this date.

Section III, management and treatment plan. This is where the form becomes a request. Item 20 prints THIS IS A PROVIDER'S WRITTEN REQUEST FOR INSURER AUTHORIZATION OF TREATMENT OR SERVICES, so whatever you list there, such as a referral, imaging, physical therapy, medication, equipment, surgery or attendant care, is what you are asking the insurer to authorize. If you need nothing, item 18 says no clinical services are indicated, and item 19 says the plan has not changed since the last report.

Section IV, functional limitations and restrictions. This is the work status, and there are three choices.

• Item 21 is no limitations or restrictions as of a date.
• Item 22 is limitations so severe the patient cannot do activities even at a sedentary level, such as during a hospitalization, with the date.
• Item 23 is a return to activity within the limits you list. The form asks you to identify only the activities that have specific limits for this patient, and the body part, and the table gives you the load, the frequency and duration, and the range of motion or position for each one, such as bend, carry, lift from floor to waist, reach overhead, sit, stand or walk.

Underneath the table the form says the restrictions apply both on and off the job, and last until the next appointment unless you change them sooner. That is worth telling your patient, because people often assume work restrictions only apply at work.

Section V, MMI and permanent impairment rating. Item 24 asks whether the patient has reached MMI, with a date, or the anticipated MMI date, or that it cannot be determined yet, and whether future medical care is anticipated. Items 25 and 26 are the percentage rating for the body as a whole, the body part, and which guide you used. Item 27 asks whether residual dysfunction or functional loss is anticipated.

Section VI and VII. The next appointment date and time, and then the attestation. By signing it you attest that the answers were made according to the instructions, to a reasonable degree of medical certainty based on objective relevant medical findings, that they are consistent with your documentation, and that they have been shared with the patient.

The boxes Florida says must be checked

I have not seen a Florida source that says which items come back incomplete most often, so I won't guess. What Florida's instructions do say is which items must be answered, and those are the ones I would look at twice before signing.

• Items 1 to 4 and 6 to 8 on the first DWC-25, and items 2, 3, 4 and 6 on every one after that.
• Item 11. One box must be checked, whatever the date of accident.
• Item 13. One box must be checked in each part of it.
• Items 14 to 17. At least one classification level must be checked.
• Item 20. At least one box, if neither item 18 nor item 19 is checked.

And the form itself asks that every section be completed legibly and accurately, with each provider limiting their answers to their own area of expertise.

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