In catastrophic Ohio workers' compensation claims, BWC relies on this treating physician evaluation to decide whether caregiver services should continue. The physician documents which activities of daily living need full or partial help, how often and for how long, along with mobility devices, hospital stays and a one-year prognosis. The form ends with a recommendation to continue or discontinue caregiver services.
The treating physician completes the whole form after examining the injured worker and signs it with a BWC provider number. No other party completes a section.
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Caregiver Services Physician's Evaluation Report
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At least annually. The instructions say the treating physician must complete the form in its entirety at least once a year to avoid delays or denial of caregiver services and reimbursement. Office notes from the same exam should document medications, the current plan of care and any new services needed.
Yes. The certification section offers two choices: continue caregiver services, or discontinue them as of a stated date. The physician certifies that the recommendation is based on an examination of the injured worker, and the prognosis section asks for a rationale.