USDA Forest Service FS-6100-16 (3/88) AGENCY PROVIDED MEDICAL CARE AUTHORIZATION AND MEDICAL REPORT (Physician or Medical Facility Form may be used for Medical Report) (Refer to FSH 5109.12) Part.

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How to fill out the FS-6100-16 online

The FS-6100-16 is a crucial document used for medical care authorization and reporting within the USDA Forest Service. This guide provides clear instructions to accurately complete the form online, making the process easier for all users.

Follow the steps to successfully fill out the FS-6100-16 online.

  1. Press the ‘Get Form’ button to access the FS-6100-16 and begin the online filling process.
  2. In Part A, enter the Medical Resource Request 'M Number' in the designated field. This number is essential for tracking your request.
  3. Fill in the procurement identification, such as BPA or Field PO Number, to help with the administrative processing of your document.
  4. Indicate the responsible payment unit for billing purposes to ensure correct financial handling.
  5. Provide the employee's name and social security number accurately. Ensure that the information matches official records.
  6. Select the employing agency from the provided options to identify the organization involved.
  7. Enter the date of injury in the format mm/dd/yyyy. This information is critical for proper medical tracking.
  8. Fill in the home unit and address of the employee to maintain accurate contact records.
  9. In the physician or medical facility section, include the initial diagnosis and necessary treatment details. Note that any surgery or hospitalization requires further authorization.
  10. Ensure the authorizing physician signs and dates the form to confirm their approval and the completion of this section.
  11. Complete Part B by providing the attending physician's report, including evaluation or diagnosis, description of treatment, prescribed medicine with potential side effects, and any work restrictions.
  12. Once all sections are completed, review the information for accuracy, then save your changes, download, print, or share the form as needed.

Complete the FS-6100-16 online today to facilitate efficient medical care documentation.

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