Get Ls Form

Filling out the Ls Form online is a vital step in ensuring proper medical treatment and documentation for workplace injuries. This guide provides clear and detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully fill out the Ls Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the document editor.
2. In Part A, complete the authorization section. Provide the name and address of the physician or medical facility authorized to examine and treat the employee.
3. Fill in the employee's name, date of injury, occupation, and details on how the accident or illness occurred in the respective fields.
4. Indicate whether the physician is authorized to provide necessary medical services by marking box A or B in item 7.
5. Complete the section for the signature and title of the authorizing official. Ensure all copies are signed.
6. Provide the name and address of the employer, including their telephone number and the date authorized.
7. Send one copy of your report to the designated office mentioned in item 12, and list the name and address of the insurance carrier or self-insured employer in item 13.
8. Once all sections are completed, review the form for accuracy, then save changes, download, or print it for your records.

Complete the Ls Form online today to ensure proper documentation of your workplace injury.