Get Ca20 Form

The Ca20 Form, also known as the attending physician's report, is essential for providing medical documentation related to employment injuries. This guide will help users navigate the online process of completing the form efficiently and accurately.

Follow the steps to successfully complete the Ca20 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's name in the provided fields. Make sure to fill in the first, middle, and last name accurately.
3. Complete the 'Date of Injury' field by entering the month, day, and year of the incident.
4. Fill in the OWCP file number in the designated area.
5. Provide a detailed history of the employment injury, including any disease, in the space provided.
6. Indicate if there is any history or evidence of concurrent or pre-existing injuries. If yes, provide details and relevant ICD codes.
7. List your findings, including results from X-rays and laboratory reports, in the designated section along with any pertinent ICD codes.
8. Specify your diagnosis related to the employment activity clearly.
9. Answer whether you believe the condition was caused or aggravated by employment activity and provide an explanation if applicable.
10. Enter the date of admission in the specified fields.
11. Indicate if hospitalization was required; if so, provide the discharge date.
12. Describe any additional hospitalization required in the remarks section.
13. Document the treatment you provided to the patient.
14. Record the date of the first examination.
15. Fill in the date(s) of treatment provided.
16. Outline the period of total disability by entering the 'From' and 'Thru' dates.
17. Enter the date the employee is capable of resuming regular work.
18. Document the period of partial disability similarly to total disability.
19. Indicate if the employee has been advised to return to work and the relevant date.
20. Describe any expected permanent effects resulting from the injury.
21. If applicable, describe the extent of physical limitations and potential types of work that could be performed.
22. Fill in any necessary remarks in the designated remarks section.
23. If the employee was referred to another physician, provide their name, specialty, and address.
24. Specify the reason for the referral in the relevant field.
25. Sign and date the form, certifying that the information is accurate to the best of your knowledge.
26. Ensure to include the physician's name and tax ID number.
27. Proceed to save your changes, and consider downloading, printing, or sharing the completed form as needed.

Complete your Ca20 Form online now to ensure timely submission and processing!