Transcription of CA-20 - Attending Physician's Report
1 HBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS451 OWCP form CA-20 InstructionsAttending physician s ReportSummaryPurposeMedical Report to support an injury or illness claim. May be used in occupationaldisease cases for follow-up Preparesa. Items 1 3 completed by the employee (see CA-20 instructions on the CA-7.)b. Items 4 32 completed by the treating to Preparea. When the CA-7 or CA-8 is At intervals to be determined by and DistributionFiling and distributing procedures are as follows:a. Original to the Copy to claimant s injury compensation Items 1 3 should be completed by the Items 4 32 should be completed by the Attending physician ; however, eithera narrative Report or another form may be : A physician s assistant, nurse practitioner, nurse, or other person notwithin the FECA definition of a physician is not acceptable as the certifyingphysician.
2 Certification by a physician s assistant will be acceptable if suchcertification is countersigned by a physician . Rubber stamp signatures arenot On receipt of the completed form from the physician , the ICCO should reviewit to ensure that the history of injury in Item 5 is consistent with the originalclaim; refer to Items 13 and 14 on the CA-1 or to Items 11 14 on the If a conflict is discovered, making allowance for terminology, typographicalerrors, and memory lapses, the claim should be evaluated for The remainder of the physician s Report should be checked for particular attention to the periods of total and partial disability toHBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS452 OWCP form CA-20 Instructions (continued)authorize COP/LWOP-IOD, and to return the employee to limited duty or fullduty at the earliest possible the event the physician forwards the CA-20 , or an acceptable narrativereport directly to the OWCP, a copy of the same should be requested fromeither the OWCP or from the employee.
3 Remember, LWOP-IOD (Code 49)should not be entered into the timekeeping system without supportingmedical EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS453 OWCP form CA-20 HBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS454 OWCP form CA-20 (continued)HBK EL-505, INJURY COMPENSATION, DECEMBER 1995 FORMS455 OWCP form CA-20 (continued)
