Insurer Activity Prescription Form

Insurer Activity Prescription Form - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Insurer Activity Prescription Form (A fillable form - 332 KB PDF)
Description

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.

Detail
Form number F242-385-000
Availability
Order it
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

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.