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How to fill out the CA 16 Form online
The CA 16 Form is essential for authorizing medical treatment or examination for employees injured while performing their duties. This guide provides a step-by-step overview to help users effectively complete the form online.
Follow the steps to successfully fill out the CA 16 Form.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
- In Part A, start by providing the name and address of the medical facility or physician authorized to provide service. This information is crucial for ensuring the right provider is linked to the case.
- Next, enter the employee’s name in the designated fields, ensuring clarity and accuracy in spelling.
- Specify the date of injury by filling in the month, day, and year in the appropriate format.
- Document the employee's occupation as it appears in their employment records.
- In the description field, provide a clear and concise explanation of the injury or disease, as detailed as possible to assist health professionals.
- Indicate your authorization for medical care to be provided for up to sixty days from the date specified in item 11. Ensure compliance with any conditions indicated in the form.
- Review the applicable options regarding the approval for issuing authorization for disease or illness, filling in the name and title of the relevant OWCP official.
- Collect required signatures, ensuring the authorizing official confirms the agreement on payment for services as indicated in item 35.
- In the final step, save the filled-out form. Options to download, print, or share the completed CA 16 Form are available to ensure proper distribution.
Complete your documents online for a streamlined experience.
The employer shall issue Form CA-16 within 4 hours of the claimed injury. If the employer gives verbal authorization for such care, he or she should issue a Form CA-16 within 48 hours. The employer is NOT required to issue a Form CA-16 more than one week after the occurrence of the claimed injury.
Fill Ca 16 Form
Send original and one copy of Form CA-. 16 to the medical officer or physician. Fillable Forms ; CA-16. DOL OWCP does not allow the issuance of a Form CA-16 if more than 7 calendar days have passed since the date of injury. Authorization for an employee to obtain medical care or treatment from a doctor or medical facility of his or her choice following an injury or illness. This form guarantees the physician payment for care provided to the injured employee. Form CA-16 is used for all traumatic injuries requiring medical attention. Following a traumatic injury which does not require emergency care, the form must be issued within four hours after the injury or after request for medical care. Form CA-16 is 2 pages in length, with 2.5 pages of accompanying instructions. The latest version is dated May 2011 and expires on 10-31-14.
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