Work ability form 2026

1. Click ‘Get Form’ to open the work ability form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, employee ID, date of injury/illness, job title, and contact details.
3. In the 'Authorization to Release Information' section, ensure the patient signs and dates this area to authorize their medical provider to share necessary information.
4. Complete the 'Treating Provider’s Evaluation' for each visit. Document details such as treatment date, nature of visit, diagnosis, and any prescribed medications.
5. Fill out the 'Return to Work' section based on the treating provider's assessment. Specify if the employee can return with or without restrictions and detail any limitations.
6. Finally, have the treating provider complete their information at the bottom of the form including their name, signature, and clinic address.

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