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This document is used for referral to a Designated Assessment Centre for insurance claims related to accidents occurring on or after January 1, 1994. It gathers information about the applicant, insurance

How to fill out designated assessment centre referral

How to fill out Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)

1. Begin by filling out the patient’s personal information at the top of the form, including name, date of birth, and contact details.
2. Indicate the referring party’s information, including name, organization, and contact information.
3. Specify the reasons for the referral by selecting the appropriate assessment required.
4. Provide detailed medical history and any relevant documents or reports to support the referral.
5. List any specific questions or concerns that the assessment should address.
6. Complete the consent section, ensuring that the patient has agreed to the assessment.
7. Sign and date the form before submission to the designated assessment centre.
8. Keep a copy of the filled-out form for your records.

Who needs Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

1. Individuals who have sustained injuries and require assessment for ongoing care or treatment.
2. Healthcare providers who need to refer patients for specialized assessments.
3. Insurance companies may require this form to process claims related to medical assessments.

For pdfFiller’s FAQs

What is Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

The Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11) is a standardized form used in Ontario, Canada, to facilitate the assessment of individuals who have sustained injuries as a result of automobile accidents. It outlines the details of the referral to a designated assessment center, specifies the assessment plan, and summarizes the findings.

Who is required to file Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

The OCF-11 must be filed by healthcare practitioners or assessors who are responsible for referring an individual for assessment at a designated assessment center after an automobile accident. This can include physicians, occupational therapists, and other qualified healthcare providers.

How to fill out Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

To fill out the OCF-11, the healthcare professional must provide detailed information about the injured person, including their personal identification, the nature of the injury, the referral details, the assessment plan, and any relevant medical history. The form must be completed accurately, signed by the healthcare provider, and submitted in the appropriate manner as directed.

What is the purpose of Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

The purpose of the OCF-11 is to ensure a comprehensive and standardized approach to assessing individuals with injuries from automobile accidents. It allows for proper communication between healthcare providers and assessment centers, ensuring that all necessary evaluations are conducted effectively and efficiently.

What information must be reported on Designated Assessment Centre Referral, Plan, and Summary Form (OCF-11)?

The OCF-11 must report specific information including the claimant's personal information, details of the accident, type of injuries sustained, assessment needs, necessary treatments, and any other relevant medical history. It should also document the healthcare provider's professional opinions and recommendations for further evaluation or care.