Activity Prescription Form (APF)

Document Information
  How to complete a fillable form.
Title Activity Prescription Form (APF)

This form is used by health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans.

Document number F242-385-000
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  • Alt Language(s)
    Valid dates 11/2014
    Contact information
    Websites Activity Prescription Form

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