Get F252-056-000 Doctor's Worksheet For Rating Cervical And Cervico-dorsal Impairment. F252-056-000

The F252-056-000 Doctor's Worksheet For Rating Cervical And Cervico-Dorsal Impairment is a vital document for assessing cervical and cervico-dorsal impairments. This guide provides step-by-step instructions to ensure users fill it out correctly and efficiently in an online format.

Follow the steps to effectively complete the doctor's worksheet.

1. Press the ‘Get Form’ button to access the worksheet and open it in your preferred editing tool.
2. Begin by filling in the claimant's name and claim number at the top of the worksheet. It is essential to provide accurate information to facilitate the rating process.
3. Answer the first set of questions regarding the worker's medical condition and its status. Indicate whether the condition has reached maximum medical improvement. If applicable, provide treatment recommendations. For any pre-existing conditions, indicate if they were aggravated by the industrial injury.
4. In the next section, determine if there is any permanent impairment by selecting 'yes' or 'no'. This is crucial for the evaluation.
5. Next, proceed to circle one option in each of the three columns labeled A through C. Each column relates to different aspects of the patient's condition: nerve root involvement, neck rigidity, and range-of-motion findings. Include brief explanations of each selection as required.
6. After making selections in the columns, you will calculate the rating total. If you want assistance with calculations, you may copy the selected numbers into the designated boxes for further evaluation.
7. Finally, certify the document by signing and dating it. Ensure you input the doctor’s name, address, and provider number. Remember to save your work, download, print, or share the completed worksheet as needed.

Take the next step in managing document submissions by completing the F252-056-000 Doctor's Worksheet online.