Follow the steps to successfully complete the online form.

1. Use the ‘Get Form’ button to access the Return To Work Program Template. This action will open the form in your editor, allowing you to begin filling it out.
2. Start by entering the injured worker's full name, including their last name and first name, in the designated fields. Ensure that all information is accurate.
3. Indicate the date recommended for vocational rehabilitation services using four digits for the year, ensuring compliance with the format specified in the instructions.
4. Select the return to work goal that applies by checking the appropriate box. Options include same job/same employer, same job/different employer, different job/same employer, and different job/different employer.
5. Fill in the allowed injury details, as well as the targeted job or job group. It's crucial that this information accurately reflects the individual's situation.
6. Choose the type of plan by checking either 'Original' or 'Amendment number' depending on your circumstance.
7. Provide the name of the service provider along with the contact person's name and phone number for communication purposes.
8. Document the total length of services to date, and specify the service dates, including 'From' and 'To' dates.
9. Estimate and record the cost of services, ensuring that you also sum the total cost of all services to date.
10. Complete the Plan of Service Approval section, ensuring that both the injured worker and the MCO representative provide their signatures and dates to validate the plan.
11. Include any required narrative justification on a separate sheet, detailing medical and vocational history, return-to-work barriers, and strategies for rehabilitation. Remember to attach this narrative to the plan.
12. Once all fields are completed, you may choose to save your changes, download the completed form, print it, or share it as needed for submission.

Get started on filling out the Return To Work Program Template online today!