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Bookmark or Share- Form CA-17 - U.S. Department of LaborForm CA-17 - Duty Status Report: This form is provided for purpose of obtaining a medical duty status report for IW. It may be issued initially with Form CA-16. Supervisor/Employing Agency completes agency portion by describing physical requirements of IW's job and noting availability of light or limited duty.
- Duty Status Report U.S. Department of LaborINSTRUCTIONS FOR COMPLETING DUTY STATUS REPORT (CA-17) Complete Side A and refer the form to the physician to complete Side B. Fill in the address of the Employing Agency and the appropriate OWCP District Office in the spaces below. Enter the OWCP file number in the top right corner.
- ca-17 - Federal Injury CentersTitle: ca-17.pdf Author: DOLMAIN Created Date: 6/26/2019 9:31:59 AM
- Justice Management Division | An Employee's Guide on ...CA-16 - Authorization for Examination and/or Treatment. This form guarantees the physician payment for care provided to the injured employee. CA-17 - Duty Status Report. This form allows the physician to keep your supervisor updated on your work restrictions and/or duty status.
- Forms | U.S. Department of LaborCA-16: Authorization for Examination and/or Treatment. This form is only available to authorized employing agency personnel, and may be obtained in electronic format via the Agency Query System (AQS) or ECOMP, or by contacting the employing agency workers’ compensation personnel. CA-17* Duty Status Report: CA-20* Attending Physician's Report ...
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