Get Dol Ca-20 1999-2026

Completing the DoL CA-20 form is an essential step in the process of submitting a physician's report for workers' compensation claims. This guide will provide clear and detailed instructions on how to fill out the form online, ensuring that users of all backgrounds can navigate it successfully.

Follow the steps to complete the DoL CA-20 form online.

1. Press the 'Get Form' button to access and open the document in the editing interface.
2. Begin by entering the patient's name in the designated fields, ensuring to include their first, middle, and last names.
3. Next, input the date of injury in the specified format (month, day, year).
4. Provide the OWCP file number in the appropriate section.
5. In the history of injury section, detail the information the patient has given regarding their injury or disease.
6. Indicate whether there is any history or evidence of concurrent or pre-existing injuries or diseases. If yes, provide descriptions and include the related ICD-9 code if applicable.
7. Outline your medical findings, incorporating results from X-rays and laboratory reports as applicable, along with the relevant ICD-9 code.
8. State your diagnosis clearly.
9. Indicate whether you believe the condition was caused or aggravated by employment activities and provide an explanation if applicable.
10. Specify if additional hospitalization is required. If yes, provide details in the remarks section.
11. Fill in the dates for the patient's admission and discharge from the hospital, if hospitalization occurred.
12. Detail the treatment provided to the patient.
13. Record the date of the first examination.
14. Document the period of total disability, specifying start and end dates.
15. Indicate the date the employee is able to resume regular work and any limits on light work, including types of work that can be performed.
16. Answer whether permanent effects are expected from the injury, providing descriptions in the remarks if necessary.
17. If a referral to another physician is necessary, provide the name, specialty, and address of the referred physician.
18. Certify the accuracy of your statements by signing the form and providing your name, tax ID number, and specialty.
19. Once all fields are completed, save your changes, and proceed to download, print, or share the form as needed.

Complete your documents online today for a smoother submission process.