Insurer Activity Prescription Form

Insurer Activity Prescription Form - (Forms/Publications)
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Title Insurer Activity Prescription Form (A fillable form - 332 KB PDF)

Used by health-care providers to communicate an injured worker's status, physical capacities, inability to work (time-loss) and treatment plans. To print an APF, click on the title of the form in the box above.

Form number F242-385-000
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Keywords activity prescription, ActivityRX, medical restrictions, physical restrictions, return to work restrictions, status, work restrictions
Languages English , English/Spanish
Valid dates 07-2009
Contact information
Web pages Insurer Activity Prescription Form

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