Physician's Report of WORK ABILITY (MEDCO-14)

The physician must complete this standard form, when the injured worker has been placed under work restrictions, requires accommodations or is temporarily totally disabled. The MEDCO-14 should be used during evaluation and management services when an injured worker’s status is evaluated or re-evaluated by a physician, usually every 30 days.

The MEDCO-14 is similar to forms managed care organizations (MCOs) or physician offices use and provide a permanent record for the physician’s file. The two-part form allows injured workers to receive a copy for their records. Fax a copy to the appropriate MCO, so employers will know their injured workers’ restrictions and explore work site adaptations/modifications.

The MEDCO-14 also contains:

• Information about to whom the form was faxed and where;
• Space for the physician’s name stamp;
• Easy check-off boxes regarding the work/non-work limitations, physician instructions, whether the injured worker is temporarily totally disabled, a request for vocational rehabilitation services, and the date and time of his or her next appointment.

This form reduces the need for phone calls among the parties to the claim regarding the injured worker’s return-to-work progress, and provides important information to injured workers regarding their recovery and work limitations. Injured workers have immediate information that they can share with their supervisors when they return to the job. In addition, employers will see the progress of their injured workers from the beginning of treatment until they are back on the job, and they will be able to assist in successful return-to-work practices.

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