Documentation & Reporting

To help L&I care for injured workers, it’s important to provide documentation and reports at the right time and in the right format.

If required documentation is missing or incomplete, your payment could be reduced or denied.

Submitting Bills and Reports correctly is also important in preventing billing delays.

Due dates for reports and forms

Required documents Due to L&I or

Report of Industrial Injury or Occupational Disease form (F242‑130‑000). To get form fax the L&I warehouse at 360-902-4525 or e-mail

Immediately – within 5 days of first visit.
Self-Insurance: Physician's Initial Report form.
To get form call L&I's Self-Insurance Section at 360‑902‑6898.

Immediately – within 5 days of first visit.
Insurer’s Activity Prescription Form
If there are work restrictions, submit this form to describe the tasks a worker can do. You can print copies of the form, order it online, or request an electronic form from L&I.

Submit with ROA or PIR after first visit, or when requested by insurer or voc counselor.

Independent Medical Exam reports
The section on General Information for Approved IME Providers tells how to write and submit IME reports.
Within 14 days of the exam or receipt of any test results.
Sixty Day narrative - Support and document the need for continued care when conservative (nonsurgical) treatment is to continue beyond 60 days. Every 60 days.
Special Reports/Follow-up Reports narrative To update L&I on the treatment and status of your patients.

As soon as possible following request by L&I or Self-Insurer.
Consultation Examination Reports narrative – Obtain an objective evaluation of the need for ongoing conservative medical management of the worker. The attending doctor may choose the consultant. At 120 days.
Attending Doctor Review of IME Report letter - Obtain the attending doctor's opinion about the accuracy of the diagnoses and information provided based on the Independent Medical Exam (IME). As soon as possible after receipt.
Loss of Earning Power form (F242‑208‑000) – Certify the loss of earning power is due to the industrial injury/occupational disease.
To get form FAX the L&I warehouse at 360-902-4525 or e-mail
As soon as possible after receipt.

Application to Reopen Claim Due to Worsening of Condition form (F242‑079‑000) – To notify L&I that the accepted condition has worsened and the claim needs to be reopened for additional treatment. Use this form if the claim has been closed for more than 60 days or for Crime Victims more than 90 days.


SOAPER format required for chart notes and narrative reports

To meet the unique need for work-status information in workers' compensation, make sure that the provider adds "ER" to the "SOAP" format in chart notes and reports.

  • S – Worker's subjective complaints.
  • O – Doctor's objective findings.
  • A – Doctor's assessment.
  • P – Plan.
  • E – Employment issues: describe the patient's physical and medical ability to work, and any rehabilitation they may need to undergo
  • R – Restrictions to recovery: Any temporary or permanent physical limitations, and any unrelated condition(s) that may impede recovery.

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