Montana law (39-71-1036, MCA) requires the treating physician or a designee to complete a Medical Status Form after every office visit with an injured worker. It supports stay-at-work and return-to-work planning by recording current work capacity, modified work abilities, MMI and impairment rating status, and follow-up timing. DLI offers three versions of increasing detail, each meeting the statutory minimum, and the provider completes one per visit.
The treating physician or designee completes the whole form. Treating physicians under 39-71-116, MCA include physicians, chiropractors, physician assistants, dentists, APRNs and physical therapists.
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Yes. DLI publishes Spanish versions of all three forms and the instructions; Version 1 is titled Formulario de Estado Médico. Which version to use is the treating physician's choice, but only one version should be completed after each visit.
Yes. DLI allows providers to program the form into their electronic medical record as long as the form name stays the same and all data fields are included, so the copies sent to the worker, employer and claims examiner carry the required content.
Yes. Section 4 has checkboxes to request an independent medical evaluation or an impairment rating, next to the MMI fields where you mark whether the worker has reached MMI, and if not, when you expect it.