What if the worker does not receive the notice?

If delivery cannot be confirmed, document efforts to notify and reissue the notice. Maintain copies of attempted delivery, confirmation requests, and any returned mail or bounce notifications to demonstrate diligence.

Can the notice be signed electronically?

Yes. Electronic signatures are legally enforceable under ESIGN (15 U.S.C. ch. 96) and UETA where adopted; confirm consent and retention capability and use appropriate authentication for consumer-facing records.

Is a notary required for the DWC 22?

Not typically required for the notice itself. If a jurisdiction or a specific process demands notarization, follow local rules; otherwise preserve delivery receipts and electronic audit logs.

How long should I keep copies?

Retain notices for the duration of the claim and at least three years after closure; retain medical records with PHI for six years in accordance with HIPAA (45 CFR §164.530(j)).

What if appointment details change?

Issue an updated DWC 22 or an amendment that clearly states revised date, time, and location, and log the change with delivery evidence to all affected parties.

Who can sign the notice on behalf of the employer?

An authorized employer representative or claims administrator may sign. Maintain delegation records showing authority to issue notices if questioned in dispute or hearing.

Electronic Signature
Templates
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DWC 22 Required Medical Examination Notice

DWC 22 Required Medical Examination Notice

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What the DWC 22 Required Medical Examination Notice Is

The DWC 22 Required Medical Examination Notice is a California workers' compensation form used to notify an injured worker of a scheduled medical examination related to a claim. It documents the date, time, location, and provider for the examination, identifies the employer and claim, and informs the worker of their rights regarding attendance and medical records. Proper completion ensures the appointment is valid for claims management, supports timely medical evaluation, and creates an auditable record for disputes or appeals.

Why the DWC 22 Matters for Claims and Care

A correctly completed DWC 22 establishes clear notice of an exam, reduces scheduling disputes, and preserves the employer’s right to obtain an independent medical evaluation for claim resolution.

Who Typically Completes or Receives This Notice

Employers, claims administrators, and treating or independent medical providers use the DWC 22 to schedule and document required examinations.

Employer/HR: Prepares notice, coordinates scheduling, and tracks compliance with claim timelines.
Claims Administrator: Sends notice, maintains audit trail, and records exam results into claim file.
Medical Provider: Receives notice, confirms appointment, and returns evaluation reports to the claims administrator.

Accurate routing and recordkeeping by these parties reduces disputes and speeds claims processing while preserving worker rights.

Step-by-step: Completing the DWC 22

Follow a consistent sequence to avoid errors and to create an auditable notice that supports timely exams and claims handling.

01

Prepare: Gather claim number, worker details, and appointment data.
02

Populate: Enter employer, provider, date, time, and location accurately.
03

Serve: Deliver notice using documented method (mail, email, or eDelivery).
04

Record: Log delivery, receipt, and any rescheduling or cancellations.

Configuring an online workflow to issue DWC 22 notices

Set validation, authentication, and notifications before deploying electronic DWC 22 notices to ensure legal and operational sufficiency.

Field	Configuration
Authentication	Email link or SMS code for signer verification
Field Validation	Enforce MM/DD/YYYY, claim number format, and required fields
Attachments	Include referral letters or prior reports as PDFs
Notifications	Automated reminders and delivery confirmations

How electronic delivery and processing typically flow

A clear digital path reduces friction: upload, assign fields, authenticate, sign, and archive with an audit trail.

Upload: Attach the DWC 22 PDF or template to the platform.
Assign: Place required fields for names, dates, and signature.
Authenticate: Use email, SMS, or stronger ID verification as needed.
Archive: Store signed notice with timestamped audit trail.

Technical considerations for eSubmission and storage

Confirm the platform supports required file formats, secure storage, and an auditable signing process before eDelive ry.

File Formats: PDF and DOCX support
Authentication: Email, SMS, or KBA options
Audit Trail: IP, timestamp, and action log

Ensure integration with claims systems and retention policies to maintain compliance and enable rapid retrieval during disputes.

eSignature platform pricing snapshot for DWC 22 workflows

Platform price and features vary; signNow leads the comparison for affordable per-user plans and usage-based site licensing for high-volume signature programs.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Security and compliance controls to protect notice data

Encryption in Transit: TLS 1.2/1.3

Encryption at Rest: AES-256

Audit & Logs: Tamper-evident audit trail

Regulatory Certs: SOC 2 Type II

Health Data: HIPAA (BAA required)

eSignature Law: ESIGN and UETA compliant

Consequences of incorrect or incomplete DWC 22 notices

Delayed Benefits: May delay medical care and indemnity payments

Claim Disputes: Increases risk of administrative hearings

Appointment Denial: Provider may refuse exam without proper notice

Record Gaps: Missing documentation complicates appeals

Regulatory Scrutiny: Repeated errors can trigger audits

Increased Costs: Rescheduling and legal review raise expenses

Common preparation errors to avoid

Omitting or transposing the claim number, which prevents providers and insurers from linking the exam to the correct file and causes administrative delays.
Leaving appointment location vague or incomplete, resulting in missed exams and disputes about whether proper notice was provided.
Failing to include provider contact information or specialty, which can block appointment confirmations or prevent timely delivery of the medical report.
Not retaining a delivery receipt or audit record of the notice, which removes critical evidence in contested claims or appeals.

Key parts of a professional DWC 22 notice

A complete DWC 22 contains specific sections that together form a legally useful notice for scheduling and documenting medical examinations.

Header

Form title and issuing agency information clearly identify the document as a DWC 22 Required Medical Examination Notice and set the legal context for the appointment and claim linkage.

Worker Details

Full legal name, date of birth, and claimant contact information help the provider match the exam to the correct person and avoid identity confusion during intake and reporting.

Claim Information

Insurer name, claim number, date of injury, and employer are recorded to ensure the medical evaluation and report can be routed to the correct claims file without processing delays.

Appointment Data

Exact appointment date, start time, and full address for the exam site must be stated so the worker and provider have unambiguous scheduling instructions.

Provider Details

Name of the examining clinician or clinic, specialty, and contact number are included so confirmations, clarifications, or cancellations can be handled promptly.

Signatures

Authorized issuer signature, printed name, and date authenticate the notice; delivery method and receiver acknowledgment, if available, should be logged to preserve the audit trail.

Real-world examples of digitizing medical exam notices

Organizations using digital forms and eSignatures report fewer scheduling errors and clearer audit trails when issuing medical examination notices for claims.

Optica Ventures LLC

Optica centralized claims paperwork into a single template for exam notices, reducing manual entry and omissions.

Reduced rescheduling by consolidating contact and claim fields.
"The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers." — Brian Fitzgibbons, COO

Fertility Centers of Illinois

A healthcare provider standardized exam notice delivery and attached pre-exam instructions as PDFs to reduce intake calls.

Improved provider confirmations through embedded contact fields.
"The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company." — John Butler, Founder

Practical tips for accurate and efficient DWC 22 completion

Follow consistent templates, validate critical fields, and maintain delivery records to reduce disputes and support timely claims decisions.

Use a validated template

Implement a locked form template that enforces required fields and standardized formats so personnel cannot omit essential claim identifiers or appointment details.

Record delivery

Always log the delivery method, date, and recipient acknowledgment; an auditable delivery record is essential for contested attendance or hearing preparation.

Protect PHI

Limit access to medical exam notices and attach a BAA with your eSignature provider when handling protected health information to meet HIPAA obligations.

Confirm and follow up

Send automated confirmations and reminders to reduce no-shows and rescheduling, and document any changes to preserve the chain of custody for the notice.

Timing considerations and processing expectations

Provide notices and confirmations with sufficient lead time, document each delivery, and allow for scheduling and reporting delays when managing exams.

Notice Issuance:

Issue the written notice promptly after exam scheduling to allow the worker time to prepare and respond.

Confirmation Window:

Request worker confirmation and log responses to demonstrate receipt and attempted delivery.

Provider Reporting:

Allow reasonable time for the provider to complete and transmit the exam report to claims staff.

Rescheduling:

Document any reschedule requests and issue an updated notice with new appointment details.

Claims Integration:

Update claim records immediately when the signed notice and report are received to maintain accurate timelines.

Key milestones in the DWC 22 process

Track these milestones from scheduling through report receipt to maintain compliance and evidence for adjudication.

01

Schedule Exam

Employer or claims handler arranges date, time, and provider for the medical evaluation.

02

Serve Notice

Issue the DWC 22 to the worker and retain proof of delivery or acknowledgment.

03

Attend Exam

Worker presents for the examination and provider documents findings in a formal report.

04

Receive Report

Claims administrator receives the medical report and files it in the claims record with audit data.

Frequently asked questions about the DWC 22 Required Medical Examination Notice

Answers to common questions about completing, delivering, and storing the DWC 22 to reduce errors and ensure compliance.

Need help? Contact support

What if the worker does not receive the notice?
If delivery cannot be confirmed, document efforts to notify and reissue the notice. Maintain copies of attempted delivery, confirmation requests, and any returned mail or bounce notifications to demonstrate diligence.
Can the notice be signed electronically?
Yes. Electronic signatures are legally enforceable under ESIGN (15 U.S.C. ch. 96) and UETA where adopted; confirm consent and retention capability and use appropriate authentication for consumer-facing records.
Is a notary required for the DWC 22?
Not typically required for the notice itself. If a jurisdiction or a specific process demands notarization, follow local rules; otherwise preserve delivery receipts and electronic audit logs.
How long should I keep copies?
Retain notices for the duration of the claim and at least three years after closure; retain medical records with PHI for six years in accordance with HIPAA (45 CFR §164.530(j)).
What if appointment details change?
Issue an updated DWC 22 or an amendment that clearly states revised date, time, and location, and log the change with delivery evidence to all affected parties.
Who can sign the notice on behalf of the employer?
An authorized employer representative or claims administrator may sign. Maintain delegation records showing authority to issue notices if questioned in dispute or hearing.

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