Get Mn Rw01 2017-2026

The MN RW01 form, or Report of Work Ability, is essential for documenting an employee's ability to work after an injury. This guide provides a step-by-step approach to effectively complete the form online, ensuring all necessary information is accurately submitted.

Follow the steps to complete the MN RW01 online

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Fill in the fields for identifying the employee, including their WID number or social security number, date of injury, and date of birth.
3. Provide the employer's name and the name of the insurer or self-insurer third-party administrator (TPA). Include the insurer claim number if available.
4. Indicate the date of the most recent examination conducted by your office by filling in the appropriate field.
5. Select the applicable option to describe the employee's work ability: 1 for able to work without restrictions, 2 for able to work with restrictions, or 3 for unable to work. Fill in the corresponding dates as required.
6. If the employee is able to work with restrictions, detail the restrictions clearly, using functional terms to explain the work limitations.
7. Indicate the date of the next scheduled visit or, if necessary, note that additional visits will be made as needed.
8. Identify the health care provider completing the report by entering their name, professional degree, license number, address, and phone number.
9. Ensure the health care provider signs the document and includes the date the report is completed.
10. After all fields are completed, save changes, and if needed, download, print, or share the form.

Complete your documents online to ensure accurate and timely submissions.