Physician Authorization of Supplemental Disability - Oregon 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the worker's name, date of injury, date of birth, and claim number in the designated fields. This information is crucial for identifying the case.
3. Fill in the primary insurer details to ensure proper communication regarding the claim.
4. In the physician's section, print their name, address, phone number, city, state, and ZIP code. This ensures that all contact information is accurate for follow-up.
5. Indicate whether the patient is medically stationary by selecting 'Yes' or 'No' and providing relevant dates if applicable.
6. Specify regular work authorization start date and any modified work dates. Clearly outline any restrictions that apply to the worker’s ability to perform their job.
7. Finally, have the physician sign and date the form to validate it before submission.

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