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Documenting
Below you will find the documents and reports required by L&I.
What records do I need to send L&I or self-insurer?
PT, OT and LMPs are required to submit legible chart notes and progress reports. Include any exercise or flow sheets that are referenced in your chart notes.
What kind of information should be included in daily chart notes?
Use the SOAP format (subjective, objective, assessment, plan). Records must verify the level, type and extent of services provided to the injured worker. Report the duration of treatment for each timed code that is billed.
When are progress reports required?
- For PTs or OTs:
- Submit your progress reports after 12 treatment visits or 1 month (whichever comes first). Send copies to:
- The attending doctor and
- L&I or self-insurer.
- For LMPs:
- Submit your progress reports after 6 treatment visits or 1 month (whichever comes first). Send copies to:
- The attending doctor and
- L&I or self-insurer.
Does L&I or self-insurer have a standard format for progress reports?
- For PTs and OTs: Yes.
- Use the Physical Therapy /Occupational Therapy Progress Report to Claim Managers form (F245-059-000). This is used to document the injured worker's progress toward clearly stated clinical goals and return-to-work objectives.
- For LMPs: No.
Is the Physical Therapy /Occupational Therapy Progress Report to Claim Managers form mandatory?
No. It's not required but is strongly encouraged.
What needs to be included on my progress report if I don't use the form above?
- Put the patient's name and claim number in upper right-hand corner of each page.
- The diagnosis/condition that is being treated.
- The dates of service covered by the report.
- Total number of visits to date for this condition.
- Number of cancelled and no-show appointments.
- Name of referring physician and date of latest referral.
- Objective findings including baseline, last progress report (if applicable), current status and objective measurable goals.
- Your estimate of the injured worker's potential to physically perform the job of injury.
- Identify alternative job goals if the injured worker is not returning to the job of injury.
- The injured worker's level of the participation in this plan of care.
- Whether or not the injured worker is making meaningful, functional progress in treatment.
- A description of the treatment plan and goals for the next set of treatments, including frequency and duration.
- An estimate of when the injured worker will be discharged from therapy.
- Your signature and the date signed.
- Your clinic name, city and phone number.
Who is required to sign chart notes and progress report?
The person performing the services must include their name, title and signature on all records submitted.
How does L&I prefer to receive claim correspondences (medical records)?
L&I prefers to receive this information by fax.
For State Fund claims:
For chart notes, reports and letters (not bills):
| Fax to any of the following numbers: | |
| 360-902-4292 360-902-4565 360-902-4566 360-902-4567 | 360-902-5230 360-902-6100 360-902-6252 360-902-6460 |
| OR | |
Mail to:
- Department of Labor & Industries
PO Box 44291
Olympia, WA 98504-4291
- Use plain, white, 8.5 x 11 inch paper. One side only. No partial sheets of paper.
- Avoid the following:
- Colored paper,
- Carbonless paper,
- Highlighter markings,
- Shaded areas, or
- Dark or black borders or logos, especially on the top border.
For self-insured claims:
Send the bills and correspondence to the self-insured employer or their representative.
