The Vermont Department of Labor has created a new form to assist physicians in providing the employer/carrier with information regarding the treatment of an injured worker. The form is called the “Health Care Provider Report” and is also known as the HCP1. The form is not required to be filed. The Department describes this as a tool to assist in obtaining relevant medical information regarding workers’ compensation injuries/illnesses.
The form is a one page document that provides basic
information such as: The employee’s name, address, date of birth and phone
number; Information regarding the injury itself, such as, the date of the
injury, the body part injured, the date of the examination, the diagnosis and
whether the injury was work related; A line is provided for documenting test
results, interpretation of the results, what medications are prescribed and
what the treatment plan is; and there is a section for a brief comment on
return to work.
This form is not required.
It does not change the law that requires that any provider seeking
reimbursement for services must provide legible, supporting documentation. Vermont Workers’ Compensation Rules,
Rule 40.021(C). That supporting
documentation is described as, “documentation for each service provided which is sufficiently detailed to allow for
the review of the medical necessity of the service and the appropriateness of
the fee charged.” Vermont Workers’
Compensation Rules, Rule 40.021(E).
The link to the new form is:
