Get Co Wc164 2019-2025

The CO WC164, or physician's report of workers' compensation injury, is a critical document used to communicate important information regarding an injured worker's condition and treatment. This guide will walk you through the essential steps to successfully complete this form online.

Follow the steps to fill out the CO WC164 effectively.

1. Click 'Get Form' button to obtain the CO WC164 form and access it for your online editing.
2. Select the report type by checking the appropriate box: ‘Initial’ for the first visit, ‘Progress’ for changes in condition, or ‘Closing’ for cases where the injured worker is at maximum medical improvement (MMI). Next, enter the exam date.
3. Fill in the case information including the date of injury, name of the injured worker, their Social Security number, date of birth, insurer claim number, insurer name, and employer name.
4. In the initial visit section, provide the injured worker’s description of the accident or injury and indicate whether the physician's objective findings align with the reported history.
5. State the work-related medical diagnosis(es) for the injured worker.
6. Complete the plan of care section, detailing the treatment plan, including diagnostic tools/tests, procedures, therapy options, medications, supplies, and other relevant treatments.
7. Document the current work status of the injured worker and check the applicable options for work limitations or restrictions.
8. Provide follow-up care and referral details, including the date of the next appointment and any referrals made to other medical providers.
9. Indicate whether the injured worker has reached maximum medical improvement, and provide any anticipated dates for reaching MMI.
10. Assess and indicate if there is any permanent medical impairment, attaching any necessary worksheets or narratives if applicable.
11. Finally, ensure that the physician responsible for the report signs it, providing their printed name, license number, and contact information.
12. After completing all sections, review the form carefully to ensure accuracy before saving changes, downloading, printing, or sharing the completed form.

Begin filling out the CO WC164 online to ensure accurate reporting for workers' compensation injuries.