Release to work form 2026

1. Click ‘Get Form’ to open the release to work form in the editor.
2. Begin by entering the Employee/Patient Information. Fill in the Social Security number, name, address, city, state, zip code, phone number, date of birth, and injury date.
3. Next, provide Employer Information. Input the FEIN number, employer's name, address, city, state, zip code, and phone number.
4. Complete the Insurance Carrier section with their name, address, city, state, zip code, and phone number.
5. If applicable, fill in the Adjusting Company details similarly.
6. Indicate whether the employee is returning to regular duty or modified duty. If modified duty is selected, specify any limitations or restrictions as needed.
7. Finally, ensure that the physician’s signature and date are included along with their name and treatment facility information before submitting.

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