Activity Prescription Form

 

The Activity Prescription Form is a powerful communication tool

L&I considers the effective use of the Activity Prescription Form (APF) as a best practice in occupational medicine. The form communicates an injured worker's physical restrictions and ability to work as well as the provider's treatment plans. In addition, workers' time-loss benefits depend on the APF and your chart notes.

Voc counselors can request an APF and other information

In addition to claim managers sometimes asking the attending provider for a new form, private vocational rehabilitation counselors are authorized to ask you to complete a new APF:

  • If they need clarification or updated information on physical capacities, or
  • If the worker's condition has changed.

If you recently submitted an APF and nothing has changed, ask the vocational provider to check the Claim & Account Center or to contact the insurer.

If you complete a new APF for a vocational provider, be sure to submit the form to L&I to ensure that you get paid for completing it.

Vocational providers may also request your review and response to:

  • Job modifications or pre-job accommodations
  • Proposed work-hardening program,
  • Plan for graduated, transitional, return-to-work (approval of job analysis or job description).

Using standard forms and limiting the information to that needed for the request and approval improves turn around and communication.

What employers can ask

Employers can contact the attending provider to clarify physical capacities related to returning to work. However, employers can't ask a provider to complete an APF. (L&I does not pay for APFs completed at the request of employers or attorneys.)

Employers can also ask providers for:

    • Concurrence with a performance-based physical capacities evaluation (PBPCE).
    • Authorization for a worker to participate in a PBPCE.
    • Approval of job descriptions or job analyses.

Using standard forms and limiting the information to that needed for the request and approval improves turn around and communication.

You can remind employers to review the completed APFs that are a part of the worker's claim file in the Claim & Account Center.Secure

Questions?

Call the Provider Hotline 1-800-848-0811 with your questions about the APF.

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.