Insurer Activity Prescription Form


Insurer Activity Prescription Form

Document Information
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Title	Insurer Activity Prescription Form (211 KB PDF)
Description	This form is used by health-care providers to communicate an injured worker's status, physical capacities, verification of inability to work (time-loss) and treatment plans. Employers and attorneys may not print or order these forms nor ask doctors to complete them. To print an APF, click on the title of the form in the box above. For more information about the form see the APF website at: www.ActivityRX.Lni.wa.gov
Detail
Form number	F242-385-000
Availability	Order it
Keywords	activity prescription, ActivityRX, medical restrictions, physical restrictions, return to work restrictions, status, work restrictions
Languages	English
Valid dates	07-2009
Contact information
Web pages	Insurer Activity Prescription Form