Get Attending Physician 's Report U.s. Department Of Labor E - Usda Wisc

Completing the Attending Physician's Report is crucial for individuals seeking workers' compensation benefits. This guide provides step-by-step instructions to help users accurately fill out the form online, ensuring a smooth process in securing necessary medical documentation for claims.

Follow the steps to effectively fill out the Attending Physician's Report.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Enter the patient’s name in the designated fields: first name, middle name, and last name.
3. Provide the OWCP file number, which is essential for processing the report.
4. Detail the history of the injury or disease as reported by the patient in section 4.
5. Indicate whether there is any evidence of concurrent or pre-existing conditions by checking ‘Yes’ or ‘No’.
6. Document your findings in section 6, including results from X-rays or laboratory reports.
7. Clearly state your diagnosis in section 7.
8. In section 8, specify whether the condition was caused or aggravated by employment activities and provide an explanation.
9. Indicate if hospitalization was required for the injury in section 9 and fill in the date of admission and discharge as needed.
10. Record the treatment you provided in section 13 and the date of the first examination in section 14.
11. Complete the sections on total and partial disability, including the relevant dates in sections 17 and 18.
12. In section 23, describe any physical limitations if the employee can only resume light work.
13. Fill out the remarks section (25) for any additional comments or necessary details.
14. Provide information for any referrals to another physician in sections 26 and 27.
15. Certify the accuracy of your statements by signing the form in section 28 and entering the date.
16. Enter your name and tax ID number in sections 29 and 30, followed by your specialty, if applicable.
17. Once all necessary fields are completed, save your changes. You can then download, print, or share the completed form as needed.

Complete your Attending Physician's Report online today to assist in the claims process.