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Insurer 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.



Form
F242-385-000


 
Job Analysis Summary

Summary that goes on top of a job analysis.  Gives the physician a snapshot of the physical demands of a job.



Form
F252-101-000


 
Job Analysis

Used by vocational rehabilitation counselors (VRCs) to document the physical demands of jobs.



Form
F252-072-000


 
Occupational or Physical Therapy Treatment Authorization Fax Request

Used by a therapy provider/clinic to request authorization for outpatient occupational or physical therapy services for L&I claims.



Form
F248-055-000


 
Physical Exam - Charter Boat Operators License

This form is used by applicants applying for a charter boat operators license to have completed by a physician for an operators license



Form
F416-056-000


 
Physical Therapy / Occupational Therapy Progress Report to Claim Managers

The physical / occupational therapist uses this report to identify the clinical goals and return to work objectives of the injured worker.



Form
F245-059-000


 





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