Get Physicians Workers' Status Report

The PHYSICIAN’S WORKERS’ STATUS REPORT is a vital document used to report an employee's medical status and ability to work following an injury. This comprehensive guide will help users navigate the online form efficiently, ensuring that all required information is accurately submitted.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the online version of the PHYSICIAN’S WORKERS’ STATUS REPORT. This will open the document for you to fill out in the editor.
2. Begin by entering the employee's name in the designated field. Ensure that you have the correct spelling and format.
3. Next, fill in the state agency and location where the employee works. This section helps in identifying the organization associated with the injury.
4. Record the date of the office visit and the date of injury in the appropriate fields, using the format applicable to public records.
5. Indicate whether this is an initial visit or a follow-up visit by checking the appropriate box.
6. Provide the time arrived and time departed during the office visit, which is essential for record-keeping.
7. Answer the question about whether the injury or illness is causally related to the employee's work by marking 'Yes' or 'No'.
8. Detail the diagnosis in the corresponding field to give clarity on the medical condition requiring reporting.
9. Specify whether there is evidence of a pre-existing condition and provide an explanation if applicable.
10. Outline the treatment plan that has been decided for the employee's recovery.
11. Indicate if a follow-up visit is needed and, if so, provide the next appointment date.
12. State whether a referral to a specialty is needed, specifying the type if it is required.
13. Provide information on the patient’s work disposition, checking the appropriate box that best describes the employee's ability to work.
14. For the appropriate work disposition checked, fill out the respective sections regarding physical capabilities, including bending, squatting, lifting, and carrying.
15. Include any potential restrictions affecting the employee's work, including assistance devices needed if applicable.
16. Provide a date for when the above restrictions are effective until, and add any comments from the physician that may be relevant.
17. Finish by including the physician's name, address, signature, and date. This ensures that the document is officially acknowledged.
18. Lastly, the employee must print their name, sign, and date the authorization to release their information.

Complete the PHYSICIAN’S WORKERS’ STATUS REPORT online to ensure a smooth process for managing workplace injuries.