Get the free NH Workers' Compensation Medical Forms - NH.gov - nh

NEW HAMPSHIRE WORKERS COMPENSATION MEDICAL FORM This form must be completed at each health professional visit (MD, DO, DC or DDS) and must be filed with the worker s compensation insurance carrier

How to fill out nh workers39 compensation medical

How to fill out NH workers' compensation medical:

1. Obtain the necessary forms: Begin by obtaining the NH workers' compensation medical forms from your employer or the NH Department of Labor website. These forms typically include an employee section to be completed by the injured worker and a healthcare provider section to be completed by the treating physician.
2. Provide personal information: Fill out the employee section of the form with your personal details such as your name, contact information, date of birth, social security number, and job title. Ensure the accuracy of this information as it will be used for communication and identification purposes.
3. Describe the injury: Clearly describe the details of the injury or illness you have sustained at work. Provide a concise account of how the incident occurred, the body parts affected, and any contributing factors. Be specific and include any additional information that might assist in the evaluation of your claim.
4. Provide medical history: Answer the questions pertaining to your past medical history honestly and thoroughly. These questions aim to determine the relationship between your work-related injury and any pre-existing conditions. Include details about any previous injuries or medical treatments that may be relevant.
5. Seek medical treatment and documentation: Seek medical treatment promptly and ensure that your healthcare provider is aware that your injury or illness is work-related. Your medical provider will complete the healthcare provider section of the form, including their professional opinion on the nature of your injury, recommended treatment, and anticipated recovery time.
6. Submit the completed form: After completing your portion of the form and ensuring that the healthcare provider section is also completed, submit the form to your employer or the designated workers' compensation representative. Keep a copy of the completed form for your records.

Who needs NH workers' compensation medical:

1. Employees injured at work: Any employee who sustains a work-related injury or illness in the state of New Hampshire is required to complete the NH workers' compensation medical form. This applies to both full-time and part-time employees.
2. Employers: Employers are responsible for ensuring that injured employees receive the necessary medical treatment and complete the required workers' compensation forms. They must provide employees with the appropriate forms and ensure that they understand the process.
3. Healthcare providers: Healthcare providers who treat injured workers in New Hampshire play a crucial role in the workers' compensation process. They are responsible for accurately documenting the nature and extent of the injuries, providing proper medical care, and completing the healthcare provider section of the workers' compensation medical form.

For pdfFiller’s FAQs

What is nh workers39 compensation medical?

NH workers39 compensation medical refers to the medical treatment and benefits provided to employees who are injured or become ill while performing their job duties.

Who is required to file nh workers39 compensation medical?

Employers are required to file NH workers39 compensation medical claims on behalf of their injured or ill employees.

How to fill out nh workers39 compensation medical?

NH workers39 compensation medical forms can be filled out by the employer or the employee's healthcare provider, with details of the injury or illness and treatment provided.

What is the purpose of nh workers39 compensation medical?

The purpose of NH workers39 compensation medical is to ensure that injured or ill employees receive necessary medical treatment and compensation for work-related injuries or illnesses.

What information must be reported on nh workers39 compensation medical?

Information such as the nature of the injury or illness, date of occurrence, medical treatment received, and employee's work status must be reported on NH workers39 compensation medical forms.

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