Get To The Attending Physician/clinician*:

Filling out the To The Attending Physician/Clinician* form is essential for ensuring clear communication between healthcare providers and employers regarding an employee's work status. This guide offers step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of the employee in the designated field. It is crucial to ensure that the name is spelled correctly to avoid any confusion.
3. Select whether the employee is under 'Industrial' or 'Non-Industrial' by checking the appropriate box.
4. Fill in the department name or number associated with the employee, as well as their employee ID number.
5. Provide the employee's job title and the date of incident or claim number in the corresponding fields.
6. Indicate the time frame of treatment by filling in the date range for the physician’s attendance.
7. Circle 'Yes' or 'No' to answer if the employee is able to work. If unable to work, specify the period they are unable to return and complete the following sections.
8. If the employee can return to modified duty or full duty, indicate the effective date by checking the relevant box and providing the date.
9. Outline the diagnosis or general nature of the employee's illness or injury, ensuring that this is done with the patient’s permission.
10. Specify any medical restrictions in the fields provided, marking the appropriate checkboxes for various activities and providing details as needed.
11. Add the estimated date the employee can return to full duty if applicable.
12. Respond to whether the restrictions are permanent by checking the appropriate box.
13. Indicate if the patient is involved in treatment requiring time off or taking medication affecting work. If yes, provide a description in the space provided.
14. Fill in the time in and time out for the appointment. Include the date of the appointment and the treating physician or clinician's signature.
15. Print or type the physician or clinician's name and include details of the next appointment.
16. Finally, ensure all sections are completed accurately, then save changes to the document, and share, download, or print as needed.

Complete your documents online today for a smoother process.