Get Workability Form Mn

Filling out the Workability Form Mn online is a crucial step for health care providers assisting employees who have incurred work-related injuries. This guide will walk you through each section of the form to ensure accurate and complete submissions.

Follow the steps to successfully complete the Workability Form Mn online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
2. Begin by entering the employee's details, including their name, WID or social security number, and date of injury in the designated fields.
3. Fill in the employer's information, ensuring to provide the correct employer name at the time of the employee's claimed work injury.
4. If known, provide the workers’ compensation insurer's information during their injury period, including the claim number.
5. Document the date of the most recent examination by your office in the specified area.
6. Select the option that accurately describes the employee’s current ability to work by checking the appropriate box. If they are able to work without restrictions, fill in the date. If they can work with restrictions, indicate the start and end dates and describe the restrictions clearly.
7. If the employee is unable to work altogether, please fill in the relevant dates as instructed for this scenario.
8. Specify the date of the next scheduled visit or indicate that future visits will be based on the employee's needs.
9. Complete the health care provider’s details by providing your name, professional degree, license or registration number, address, and phone number.
10. Finally, ensure all information is accurate, sign the form, and provide the date signed.
11. Once everything is filled out, you can save the changes, download, print, or share the completed form as needed.

Complete your Workability Form Mn online today to support employees effectively.