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LS-204 Attending Physician's Supplementary Report

After the initial LS-1 report, the attending physician uses this form for progress reports on a Longshore Act injury and for the final report at discharge. It covers present condition, treatment dates, permanent loss of function or disfigurement, work status and limitations, return-to-work estimates, causation and rehabilitation. OWCP uses it to determine the injured worker's entitlement to compensation and medical benefits.

Who completes it

The attending physician completes and signs the whole form. The employee and employer do not complete any part.

Submitting and payment

How to submit it
Send the original to the OWCP district director and one copy to the insurance carrier or self-insured employer, about every 30 days during treatment and again at discharge.
Who pays
The employer or its insurance carrier pays for the attending physician's care under the Longshore Act.

Good to know

  • A narrative report covering everything on the form may be sent instead. Enter NA for questions that do not apply and use Remarks for overflow.
  • The exact point of amputation or other permanent partial impairment must be known for OWCP to determine compensation, so describe it fully in item 11.
  • Items 7b and 7c apply only if you have not filed an earlier report giving history; for occupational disease, include occupational history and the date symptoms began.
  • Item 15 asks whether the described occurrence was the competent producing cause of the injury and disability. Revised November 2023, OMB 1240-0014.

Get the official form

Download the current version from the source each time; forms change without notice.

Attending Physician's Supplementary Report

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How often should LS-204 be filed?

About every thirty days while the patient is under your care, with a final report when the patient is discharged. The original goes to the OWCP district director and one copy to the insurance carrier or self-insured employer.

Can I send a narrative instead of Form LS-204?

Yes. The instructions allow a narrative report as long as it covers all the information the form requests, including present condition, treatment, work limitations, return-to-work dates, causation, rehabilitation and any permanent impairment.