Washington physical and occupational therapists treating injured workers file this report monthly or by the 12th visit, whichever comes first. It covers visits, cancellations and no-shows, work status, functional progress, up to four essential job tasks, objective measurements, outcome scores, barriers to recovery and the treatment plan. L&I relies on it for further authorization, and the attending provider can respond on page two.
The physical or occupational therapist completes sections 1-5 and signs. The attending provider may complete the optional section at the end, agreeing with the plan, ending treatment or changing it, and returns a signed copy to the clinic.
Download the current version from the source each time; forms change without notice.
Physical Medicine Progress Report
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Monthly or by the 12th visit, whichever comes first. L&I's physical medicine policy repeats that progress reports are due after 12 visits or every month, and warns that requests for visits beyond 24 may be denied if a progress report and chart notes are not on file.
The AP section is optional. It lets the attending provider agree with the recommendations and update the Activity Prescription Form, state that no further treatment is needed, or change the plan of care. If the AP returns a signed copy to the clinic, the therapist sends it on to L&I.