Get Wc 2 Form Hawaii

The Wc 2 Form Hawaii is essential for reporting physicians' assessments regarding work-related injuries and treatment. This guide provides a step-by-step approach to help you complete the form accurately and efficiently online.

Follow the steps to fill out the Wc 2 Form Hawaii online correctly.

1. Press ‘Get Form’ button to access the Wc 2 Form and open it in your editor.
2. Input the DCD case number if known. This number helps in tracking the claim and associated details.
3. Enter the employer’s name and address accurately to ensure proper identification of the employer involved.
4. Fill out the carrier's or adjuster's name, address, and telephone number for contacting the insurance provider.
5. Input the physician’s name, address, and telephone number, as this provides essential contact details for the reporting doctor.
6. Provide the patient’s full name and current address as recognized on their identification.
7. Include the carrier's claim number, if available, to correlate with the insurance records.
8. Enter the physician's tax identification number or state license number, which is necessary for compliance.
9. Specify the date of injury or illness in the mm/dd/yy format, which is critical for record-keeping.
10. Indicate the date of first treatment for the injury, using the same date format for consistency.
11. Describe the accident clearly in the patient’s own words to convey how the injury occurred.
12. Check the appropriate box to indicate the type of report: first, first and final, interim, or final.
13. Enter the diagnosis along with the corresponding ICD-9CM or CDT code for medical documentation.
14. Provide a brief description of the injury and specify the affected body parts.
15. State whether the accident is the sole cause of the patient’s condition and list any additional contributing factors if applicable.
16. Detail the current complaints, disability status, and the date the patient was released to work.
17. Select the prognosis regarding recovery, indicating if full recovery is anticipated or if it is not.
18. Mark the expected date to achieve maximum medical improvement and assess any permanent impairments.
19. Complete the proposed treatment plan, indicating start and end dates, and the estimated cost.
20. Ultimately, review all entries for accuracy before saving changes or downloading the completed form.

Complete your Wc 2 Form Hawaii online today to ensure timely processing of your claims.