Follow the steps to complete the M1 Diagnostic Medical Report online.

1. Click ‘Get Form’ button to obtain the M1 Diagnostic Medical Report and open it in your editor of choice.
2. In the first section, fill in the employer name and mailing address. Provide the name and mailing address of the insurer as well, including the claim number if known.
3. Complete the section for third-party administrator information, if applicable, and then enter the employee's name, last four digits of their social security number, date of birth, and date of injury.
4. Indicate the patient complaints and the date of examination followed by using either ICD-9 or ICD-10 codes for diagnosis. Clearly state if the diagnosis is work-related or not.
5. If diagnostic tests have been performed, indicate 'yes' and list the tests. Also, provide the date for the next appointment and the estimated length of treatment required.
6. Select from the treatment plan options by checking all that apply, such as medications, medical referrals, rest, therapy, office procedures, etc.
7. Determine the patient’s work capacity by selecting regular duty, no work capacity, or modified work. Provide details of any restrictions and estimated length of such restrictions if applicable.
8. Indicate any expected permanent impairment and provide ratings where necessary. Ensure all body parts affected are checked accurately.
9. Complete the healthcare provider's section by signing, printing the name, providing the address and telephone number.
10. Once all sections are complete, users can save changes, download, print, or share the completed M1 Diagnostic Medical Report.

Begin filling out the M1 Diagnostic Medical Report online today!