Get This Form Provides Important Information About The Injured Workers Ability To Work

This guide provides users with a clear and comprehensive approach to completing the form that details the injured worker's ability to work. By following these step-by-step instructions, users can efficiently gather and input the necessary information online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to retrieve the form and open it in the editor.
2. In the form, begin by entering the injured worker's name, claim number, date of injury, employer name, and the position held at the time of injury. Make sure this information is accurate to avoid delays.
3. For the injured worker progress section, indicate how the worker is progressing and if there are any changes from previous reports. This helps in tracking recovery.
4. In the work status section, review or obtain a copy of the worker's job description and select the appropriate option regarding their ability to work. This section includes checking whether the worker can return to their former position or if they need restrictions.
5. Fill out the injured worker's capabilities section thoroughly. Specify tasks they can perform and the extent of their abilities related to lifting, carrying, and other physical activities throughout a typical workday.
6. In the disability period information section, provide a narrative description of the injuries, including the ICD codes and whether they are causing temporary total disability.
7. Complete the clinical findings section, detailing the medical rationale for any delays in recovery and barriers to returning to work.
8. In the maximum medical improvement section, indicate if the worker has reached MMI and provide the date or proposed treatment plans if not.
9. Address the vocational rehabilitation needs of the worker, indicating if they are a candidate for programs designed to assist in returning to work.
10. Finally, ensure that the treating physician signs and dates the form, certifying that all information is correct and complete.
11. After filling out all sections, save changes, and you can download, print, or share the completed form as needed.

Start filling out the form online today to ensure proper documentation of the injured worker's ability to work.