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Supervisors medical treatment form 2025

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The document outlines the procedures for reporting and managing workplace injuries at NC State University. It includes a Supervisor’s Medical Treatment Authorization form that must be completed by supervisors and medical providers, detailing patient information, treatment provided, work status, restrictions, and follow-up appointments. It also provides contact information for HR Benefits and Environmental Health & Safety, authorized treatment facilities in Wake County, and instructions for pharmacies regarding prescription processing for injured employees.

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What is a CA-16 form used for?

Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.

What to do when an employee refuses medical treatment?

Document the Refusal If your organization has a Refusal of Treatment form, get a copy and ask the employee to fill it out and sign it. Be sure to have a witness sign it as well. If you dont have such a form on hand, make sure to include all this information in your incident report.

What is the CA16 form?

Medical Treatment - Form CA-16. If an employee requires medical treatment for a traumatic injury, supervisor should complete front of Form CA-16, within four hours of request whenever possible. If supervisor doubts whether employees condition is related to employment, he/she should so indicate on Form CA-16.

When can CA-16 be issued?

A CA-16 can be issued up to 48 hours after the employee has been treated. If the employee provides a medical report within 48 hours or treatment indicating the condition is work-related, a CA-16 can be issued with supervisory approval.

How does the federal leave buy back work?

Things to Know About Leave Buy Back: In order for leave to be reinstated, the employee must refund to the agency the difference between the compensation entitlement and the total amount of leave paid by the agency. The employees pay status must be changed to LWOP in order for compensation to be paid.

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What not to say to a workers comp doctor?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

Can you refuse treatment on workers comp?

Common reasons for refusing treatment include concerns about the effectiveness or safety of a particular treatment, preference for alternative therapies, or personal beliefs. In California, injured workers generally have the right to refuse medical treatment for their work-related injuries.

What is an example of refusal of medical treatment?

Most people in the United States have a right to refuse care if treatment is for a non-life-threatening illness. This may include not getting a prescription filled, not getting a flu shot, or deciding to stop using crutches after you sprained an ankle.

Supervisors medical treatment form 2025

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What is a CA-16 form used for?

What to do when an employee refuses medical treatment?

What is the CA16 form?

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What not to say to a workers comp doctor?

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