Insurer Activity Prescription Form - Spanish Formulario de Restricciones Laborales del Asegurador
See also
| Document Information | ||
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 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Insurer Activity Prescription Form - Spanish Formulario de Restricciones Laborales del Asegurador (56 KB PDF)
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| Description | Used by Spanish speaking health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans. Utilizado por proveedores de cuidado de la salud que hablan español para indicar la condición actual del trabajador lesionado, restricciones físicas, certificación de tiempo perdido y planes de tratamiento. |
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| Detail | ||
| Form number | F242-385-909 | |
| Availability | Online only. See document above to download. |
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| Keywords | discapacidades, progreso del trabajador, Restricciones físicas, restricciones laborales, restricciones para regresar a trabajar | |
| Languages | English/Spanish , English | |
| Valid dates | 07-2009 | |
| Contact information |
Claims for Job Injuries
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