SOVA: Physicians Disability Report Lost Wages PSD26 Rev. 07/14 State Office of Victim Assistance: 1205 Pendleton St., Brown Bldg., Room 401, Columbia, SC 29201 Fax 803.734.2261 WWW.SOVA.SC.GOV ****.
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How to fill out the SC PSD26 online
Filling out the SC PSD26 form, also known as the Physician’s Disability Report for Lost Wages, is an essential step for individuals seeking compensation for lost wages due to a documented disability resulting from a crime. This guide provides clear, step-by-step instructions to help you navigate the online form with confidence.
Follow the steps to successfully complete the SC PSD26 form.
- Click ‘Get Form’ button to acquire the form and open it in the digital editor.
- Enter the legal name of the crime victim or injured patient in the designated field.
- Provide the last five digits of the Social Security number of the patient.
- Fill in the patient's date of birth using the format: mm/dd/yyyy.
- Record the date the patient was first seen in relation to the crime, ensuring to use the format: mm/dd/yyyy.
- Document the date of the crime-related injury, which is a required field, using the format: mm/dd/yyyy.
- In the space provided, briefly describe the injuries sustained as a direct result of the crime.
- The treating physician must indicate the start and end dates of the disability period for the patient in the specified fields, using the format: mm/dd/yyyy.
- Select the appropriate box indicating whether the patient may resume work immediately or with restrictions, and specify any restrictions if applicable.
- If applicable, fill in the dates the patient may return to work at full capacity or partial capacity, using the format: mm/dd/yyyy.
- Enter the date of the patient’s next appointment, also using the format: mm/dd/yyyy.
- Type or print the treating physician's name and complete the phone number in the designated fields.
- The treating physician must sign and date the form in the appropriate sections.
- Finally, review all entries for accuracy. Users can then save changes, download, print, or share the completed form as necessary.
Complete your SC PSD26 form online to ensure your lost wages are reported accurately.
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