| Insurer Activity Prescription Form |  | |
About the Insurer Activity Prescription Form (APF)
The APF has been updated. Please use the version dated July 2009 (7/09) on the bottom of the front page. Recycle all of the old APFs in your office (dated 8/07). Guidelines for when to use the APF have not changed. Go to the "Authorization" tab above for more explanation.
The APF communicates:
- Work status,
- Work-related physical restrictions,
- Verification of time-loss, if appropriate, and
- Treatment plans.
Note: Health care providers in the Centers of Occupational Health & Education and the Orthopedic/Neurologic Pilot Projects will continue to follow the APF use and billing instructions provided by those projects.
Health care providers will continue to be paid for activities supporting return-to-work including:
- Consultation with employers and VRCs, and
- Review of job descriptions and job analyses.
State Fund employers can clarify physical capacity information by contacting the attending provider or obtain it by:
- Using attending provider-completed APFs that are a part of the worker's claim file and can be viewed in L&I's Claim and Account Center,
- Asking attending providers for information regarding return to work. Both VRCs and State Fund employers may seek:
- concurrence with a performance based physical capacities evaluation (PBPCE).
- authorization for worker to participate in a PBPCE.
Effective September 14, 2009, Private VRCs may request an APF from the provider if clarification or updated physical capacity information is needed or wroker condition has changed.
- Return the APF to the department to ensure payment for completion of the form.
- You are encouraged to fax the APF to expedite return to work services.
Additionally, VRCs may ask a provider to review and respond to:
- job modification or pre-job accommodation.
- proposed work hardening program.
- plan for graduated, transitional, return-to-work.
- request clarification of information on an APF that relates to return-to-work.
Attention Providers:
You may respond to an employer’s or VRC's request for a worker's physical restrictions:
- to help with return to work efforts,
- if you have not provided that information on an Activity Prescription Form (APF) submitted with the report of accident or at the insurer’s request.
- if the restrictions you have previously provided on an APF have changed.
Bill code 1074M for this service.
If you’ve recently submitted a completed APF and nothing has changed, inform the employer or VRC that they can obtain the workers’ physical restrictions from the insurer.
Call the Provider Hotline 1-800-848-0811 with your questions about the APF.
