Ohio form acceptance 2026

1. Click ‘Get Form’ to open the Ohio Form Acceptance in the editor.
2. Begin by entering the employer information, including the company name and phone number. This ensures that all communication is directed correctly.
3. Fill in the employee's details such as their name, date of injury, policy number, and claim number. Accurate information here is crucial for processing.
4. In the transitional work offer section, specify the date when the physician released the employee to return to work with restrictions. Include the physician's name and program start date.
5. The employer must acknowledge that all provided information is correct by signing and dating the form. This step confirms accountability.
6. The employee should then indicate their agreement or refusal to participate in transitional work activities by signing and dating where indicated.
7. If unable to obtain an employee signature post-return, complete the agreement verification section based on applicable reasons.
8. Finally, fax the completed form to your managed care organization (MCO) using one of the provided fax numbers for submission.

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