Fill out Form CA-20, Attending Physician's Report with Instafill.ai

Box 6 of the Attending Physician's Report is used to document the objective findings and diagnostic test results related to the patient's injury. Objective findings refer to observable and measurable symptoms, such as swelling, bruising, or abnormal lab results. Diagnostic test results may include X-rays, MRI scans, or other imaging studies. It is important to provide as much detail as possible about any tests that were performed and the results of those tests.

Box 7 of the Attending Physician's Report is used to document the medical diagnoses related to the patient's injury. Acceptable diagnoses may include any condition or injury that is related to the work incident. This may include acute injuries, such as fractures or lacerations, as well as chronic conditions that were aggravated or accelerated by the work incident. It is important to note that the diagnoses must be supported by objective findings and diagnostic test results.

Box 9 of the Attending Physician's Report is used to explain the causal relationship between the patient's work injury and the diagnoses. It is important to provide a clear and concise explanation of how the work incident contributed to the patient's injuries or diagnoses. This may include a description of the mechanism of injury, the sequence of events leading up to the injury, and any objective findings or diagnostic test results that support the causal relationship.

In Box 9 of the Attending Physician's Report, it is important to distinguish between different types of causal relationships between the work injury and the diagnoses. The following definitions may be helpful: * Direct causation: The work injury was the sole cause of the patient's diagnoses. There would be no diagnoses if the work incident had not occurred. * Aggravation: The work injury made an existing condition worse. The patient may have had the condition before the work incident, but the injury exacerbated it. * Acceleration: The work injury caused a condition to develop more quickly than it would have otherwise. The patient may have been at risk for the condition, but the work incident brought it on more rapidly. * Precipitation: The work injury was the trigger for the patient's diagnoses, but the condition would have eventually developed on its own. It is important to provide a clear and concise explanation of which type of causal relationship applies to the patient's case.

Box 10 of the Attending Physician's Report is used to indicate the patient's disability status and the dates of such disability. The attending physician should check the appropriate box based on the patient's condition: (1) No work restriction, (2) Work restriction with no wage loss, (3) Work restriction with wage loss, or (4) Death. If the patient has a work restriction, the attending physician should also provide the start and end dates of the restriction.

If the patient is partially disabled, the attending physician should provide a description of the patient's condition and the percentage of disability in Box 11. The percentage should be based on the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, 6th Edition.

Box 13 of the Attending Physician's Report is used to indicate the attending physician's name, signature, and the date of the examination. The physician should also provide their medical license number and the name and address of their medical practice or facility.

The completed Attending Physician's Report and any associated bills should be sent to the following address: Office of Workers' Compensation Programs, P.O. Box 6916, Jacksonville, FL 32231-6916.

To upload the completed Attending Physician's Report and any associated bills directly into the patient's case file using ECOMP, the user must first log into their ECOMP account. Once logged in, they should navigate to the 'Medical' tab and select 'Attending Physician Reports' or 'Bills'. The user can then upload the documents by clicking the 'Add' button and selecting the file(s) to upload. It is important to ensure that the document(s) are in a compatible format, such as PDF or TIFF.

Failing to disclose all requested information in the Attending Physician's Report (APR) may result in delays or denial of payment for services or benefits. It is important to provide accurate and complete information to ensure proper processing of the claim.

The Privacy Act Statement in the APR is a notice that explains how your personal information will be used and disclosed. It covers information that can be used to identify you, such as your name, address, and Social Security number. The statement also explains your rights under the Privacy Act, including the right to access and correct your information.

The Public Burden Statement is a notice that explains the estimated time and costs to the public for complying with the collection of information in the APR. The estimated reporting burden for this form is approximately 20 minutes for the completion of the form and the maintenance of records. This estimate may vary depending on the complexity of the case.

A compensable diagnosis is a medical condition that is recognized and covered under a particular insurance or benefit program. In Box 7 of the APR, a compensable diagnosis refers to a diagnosis that is related to the injury or illness for which the report is being submitted. A diagnosis of 'pain' is a symptom, not a specific diagnosis. It is important to provide the specific diagnosis related to the injury or illness, if known.

If the patient has a disability and requires accommodations or auxiliary aids and services to complete the APR, the patient or their representative should contact the appropriate insurance or benefit program to request accommodations. The program may provide alternative formats of the form, such as large print or audio, or may offer assistance in completing the form. It is important to ensure that all necessary information is provided to allow for proper processing of the claim.

For orthopedic conditions, the Attending Physician's Report (APR) form, also known as the Department of Labor (DOL) Form OWCP-18, is typically used for work capacity evaluations.

For psychiatric conditions, the Mental Status Questionnaire (MSQ) form, also known as the DOL Form OWCP-19, is typically used for work capacity evaluations.

For cardiac conditions, the Cardiac Consultation Report (CCR) form, also known as the DOL Form OWCP-20, is typically used for work capacity evaluations.

The physician must sign and date the form in Box 13 to certify that they have examined the patient and have provided their professional opinion regarding the patient's work capacity based on the information provided on the form.

A physician is any person who practices medicine or surgery, or is licensed, certified, or otherwise authorized to practice medicine or surgery by the state in which the services are performed. A qualified physician, as referred to in Box 13, is a physician who is qualified under the Federal Employees' Compensation Act (FECA) to provide medical treatment and make work capacity evaluations for federal employees.

Submitting medical bills on forms other than the HCFA 1500/OWCP-1500 form may result in processing delays or rejections, as the Office of Workers' Compensation Programs (OWCP) may not be able to process claims using forms that are not standardized for their system.

Failing to provide the patient's case number, last name, date of birth, and date of injury when uploading a document on ECOMP may result in processing delays or rejections, as the OWCP requires this information to properly identify and process the claim.