Get Provider Management Plan Form 032 - Q-comp

Filling out the Provider Management Plan Form 032 - Q-Comp online is crucial for managing a worker's rehabilitation effectively. This guide provides clear and detailed instructions to help you navigate the process step-by-step.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by entering the worker's details, including their name, date of birth, and other personal information. Ensure accuracy in filling out this section as it is fundamental for identification.
3. Provide the Provider Management Plan number, date of initial consultation for the present injury, and the diagnosis. This information is essential for tracking treatment effectiveness.
4. Indicate the total number of consultations approved to date and the claim number. This section helps maintain clarity on the treatment progress.
5. List the number of consultations required in this plan. Enter the referring doctor's name and include the provider's contact details. It is crucial that the treating provider’s name and contact phone number are printed or stamped.
6. Outline the treatment plan by specifying the dates and types of consultations being provided, including item numbers and number of services or costs associated with each.
7. Detail the outcome measures used to assess and monitor the worker’s progress throughout the treatment. Include current measures and anticipated outcomes for the initial assessment and at the end of the current plan.
8. Identify any barriers to return to work and recommend strategies to overcome these barriers. This section aims to support the worker's rehabilitation effectively.
9. Fill in the insurer approval section by indicating whether the plan is accepted as proposed or modified. Ensure to provide the case manager’s name, signature, telephone number, and date for record-keeping.
10. Review the completed form for accuracy, save your changes, then download, print, or share the form as necessary. Ensure to submit the completed plan to the insurer before the last approved session.

Start completing your Provider Management Plan Form 032 - Q-Comp online today to ensure efficient processing.