Get Fax Note:

Completing the Fax Note: is a crucial step for physicians when reporting the work ability of an injured worker. This guide will provide clear steps to fill out this important document accurately and efficiently online.

Follow the steps to complete the Fax Note: effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the injured worker name and claim number at the top of the form. This information identifies the worker and their specific claim.
3. Next, indicate the details of the physician such as the 'To' and 'From' sections, providing contact information including toll-free phone numbers and fax numbers.
4. Fill in the Social Security Number if the claim number is unknown. Ensure to include the date of injury and the injured worker’s occupation, along with the employer's name.
5. Specify the work capabilities using options provided. Indicate whether the injured worker may return to work with or without restrictions and provide dates for restriction, if applicable.
6. Detail the work and non-work capabilities, including any specific restrictions such as lifting limits and activities the worker should avoid.
7. Provide an explanation of why the injured worker is unable to perform work, referencing specific ICD-9 codes for the conditions being treated.
8. Indicate the estimated return to work date and if the injured worker has reached maximum medical improvement.
9. Complete the physician's name and address; check if vocational rehabilitation services are recommended before signing the form.
10. Finally, review all information for accuracy, then save changes, download, print, or share the completed form as needed.

Complete your documents online with confidence today.