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Get Dol Ca 17
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How to fill out the Dol Ca 17 online
The Dol Ca 17 form, also known as the duty status report, is essential for documenting an employee's work-related injury status. This guide offers a step-by-step approach to completing the form online, ensuring accurate submission to facilitate the benefits process.
Follow the steps to complete the Dol Ca 17 form online
- Press the ‘Get Form’ button to retrieve the Dol Ca 17 and open it in your document editor.
- On Side A, as a supervisor, fill in the employee's details, including their name, date of injury, and OWCP file number if known. Ensure to enter the address of the Employing Agency and the appropriate OWCP District Office.
- Indicate the employee's social security number and major occupation. Additionally, describe how the injury occurred, specifying the body parts affected.
- Detail the employee's work schedule by entering the number of days they work per week and hours they work per day.
- In the activity section, check the boxes that apply to the employee's usual work requirements, such as lifting, sitting, and bending. For each check, provide details about the frequency and duration.
- Address whether the employee is advised to resume work. If so, include the date; if not, complete the additional requirements on Side B.
- On Side B, the physician must complete their section, providing medical assessments and signing the form. They should return the completed form to the employing agency.
- Once both sides are completed, save your changes. You may then download, print, or share the completed Dol Ca 17 form as needed.
Complete your Dol Ca 17 form online to ensure a smooth claims process.
As mentioned previously, the injured employee or their designated representative fills out the CA-17 form. This important document includes details about the injury and the required medical treatment. Accurately filling out this form is vital for quick benefit processing. Engaging with the right resources, such as our platform, can simplify handling the Dol Ca 17 paperwork.
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