Workers’ Compensation Nurses Section Referral Form Document Template

Due to popular demand, the N.C. Industrial Commission has created a Microsoft® Word document template for Workers’ Compensation Nurses Section Referral Form. After you download this file and install it in your document template directory, you may open a new document based on this template by opening Microsoft Word, going to the Menu Bar, selecting File, choosing New, and then double-clicking on the Nurseref icon.

NOTE:  You may modify NURSEREF.DOT to include the employer’s name, address, telephone number, etc., by opening the template in Microsoft Word, choosing Tools from the Menu Bar, selecting the Unprotect Document option, and filling in the appropriate blanks. Afterwards, you must select Tools, choose Protect Document, click Forms:, click OK, and then save (Ctrl S) the template.

The Industrial Commission requires that all forms be submitted on white paper and no colored forms will be accepted from this point forward due to the use of an electronic document management system. Paper forms are converted to images and the color is no longer useful but degrades the quality of the electronic image. 

Workers’ Compensation Nurses Section Referral Form Document File

If you prefer to download a document version of Workers’ Compensation Nurses Section Referral Form, click here.

NOTE:  You may modify Workers’ Compensation Nurses Section Referral Form to include the employer’s name, address, telephone number, etc., by opening the document in Microsoft Word, choosing Tools from the Menu Bar, selecting the Unprotect Document option, and filling in the appropriate blanks. Afterwards, you must select Tools, choose Protect Document, click Forms:, click OK, and then save (Ctrl S) the document.

Workers’ Compensation Nurses Section Referral Form PDF File

You may print and then fill out the following PDF (Portable Document Format) version of the Workers’ Compensation Nurses Section Referral Form, and submit it to the commission in lieu of the NCIC’s preprinted forms. To view or print this PDF file, you first must download and install a copy of the Adobe® Acrobat® Reader. Click the button below to obtain your FREE copy of Adobe® Acrobat® Reader. (NOTE: Please pay close attention to this software’s installation instructions and licensing agreement.)

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Click here to view or download PDF versions of all N.C. Industrial Commission forms.


N.C. Industrial Commission ·   Medical Rehabilitation Nurses Section
4341 Mail Service Center ·   Raleigh, NC 27699-4341
Telephone: (919) 807-2617 ·   Fax: (919) 807-2699
NCIC Home Page: http://www.ic.nc.gov/