Dwc Form Pr-2 Primary Treating Physician'S Progress Report Page 2
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2PRIMARY TREATING PHYSICIAN’S PROGRESS REPORT (PR-2)
Work Status: This patient has been instructed to:
Remain off-work until___________.
Return to modified work on________________________ with the following limitations or
restrictions
(List all specific restrictions re: standing, sitting, bending, use of hands, etc.):
Return to full duty on ___________________with no limitations or restrictions.
Primary Treating Physician: (original signature, do not stamp)
Date of exam: _________________
I declare under penalty of perjury that this report is true and correct to the best of my knowledge and that I have not
violated Labor Code § 139.3.
Signature: ____________________________________ Cal. Lic. # ______________________________
Executed at: ___________________________________ Date: __________________________________
Name:________________________________________ Specialty: ________________________________
Address:______________________________________ Phone:___________________________________
DWC Form PR-2
2
(Rev. 06-05)
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