Activity prescription form 2026

1. Click ‘Get Form’ to open the activity prescription form in the editor.
2. Begin by entering the worker’s name, visit date, and claim number at the top of the form. This information is crucial for identifying the case.
3. Fill in the health-care provider’s name and date of injury. Ensure accuracy as this will be referenced in future communications.
4. Indicate whether the worker is released to their job without restrictions or if they may perform modified duties. If applicable, specify dates and check relevant options.
5. In the 'Capacity' section, estimate what tasks the worker can perform and provide key objective findings. Use the provided scales (e.g., seldom, occasional) to detail their capabilities.
6. Complete any additional notes or instructions regarding restrictions or rehabilitation progress before signing off on the document.

Start using our platform today for free to streamline your document editing and form completion!