Intellect™
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Worker
Sample WC Forms
Sample 10770.5 & .6, DEU100 & 101, DWC6 & 100, QME109 - 112, & 122
Prime Clinical Systems makes every attempt to have the most current WC Forms included in Intellect. If a form is not available, please contact Prime Clinical Systems via support@primeclinical.com and include a copy of the form that is in question. In the subject line, please put FORMS DEPT, and in the text of the email, please include your client ID and a contact phone number.
Click on the alphabetized list of report titles to view a form sample and to access the link to a .pdf of that form.
DEU100 - This is a 2-page report. There is a separate .pdf for each page.
DEU101 - This is a 4-page report. There is a separate .pdf for each page.
DWC6 - This is a 3-page report. There is a separate .pdf for each page.
DWC100 - This is a 2-page report. There is a separate .pdf for each page.
QME111 - This is a 4-page report. There is a separate .pdf for each page.
Note: This is page one of a two-page report. There is a separate .pdf for each page.
Page 1
Note: This is page two of a two-page report. There is a separate .pdf for each page.
Page 2
Note: This is page one of a four-page report. There is a separate .pdf for each page.
Page 1
Note: This is page two of a four-page report. There is a separate .pdf for each page.
Page 2
Note: This is page three of a four-page report. There is a separate .pdf for each page.
Page 3
Note: This is page four of a four-page report. There is a separate .pdf for each page.
Page 4
Note: This is page one of a three-page report. There is a separate .pdf for each page.
Page 1
Note: This is page two of a three-page report. There is a separate .pdf for each page.
Page 2
Note: This is page three of a three-page report. There is a separate .pdf for each page.
Page 3
Note: This is page one of a two-page report. There is a separate .pdf for each page.
Page 1
Note: This is page two of a two-page report. There is a separate .pdf for each page.
Page 2
Note: This is page one of a four-page report. There is a separate .pdf for each page.
Page 1
Note: This is page two of a four-page report. There is a separate .pdf for each page.
Page 2
Note: This is page three of a four-page report. There is a separate .pdf for each page.
Page 3
Note: This is page four of a four-page report. There is a separate .pdf for each page.
Page 4
