Last updated on Mar 23, 2026
CA Form 1013336 free printable template
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What is CA Form 1013336
The Physician's Return-to-Work & Voucher Report is a healthcare document used by physicians to inform employers about an employee's work capabilities and restrictions following a permanent partial disability.
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Who needs CA Form 1013336?
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CA Form 1013336 is needed by:
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Physicians treating injured employees
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Employers managing workplace injuries
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Claims administrators handling workers' compensation
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Employees with permanent disabilities requiring work assessments
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Medical evaluators determining work capacity
Comprehensive Guide to CA Form 1013336
What is the Physician's Return-to-Work & Voucher Report?
The Physician's Return-to-Work & Voucher Report (DWC AD Form 10133.36) serves as a crucial document in California for managing employee injuries that occur on or after January 1, 2013. Its primary purpose is to communicate the work capabilities and restrictions of injured employees, ensuring a structured transition back to work.
This report is pivotal in facilitating interactions between physicians, employers, and injured employees. The primary treating physician or medical evaluators are responsible for completing this form, thereby playing a key role in its effective use.
Purpose and Benefits of the Physician's Return-to-Work & Voucher Report
This form holds significant value for both physicians and patients by clearly conveying work capacities and any necessary restrictions to employers. By effectively communicating these aspects, the form aids in creating a safe environment for injured employees as they return to work.
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Ensures compliance with California workers' compensation laws.
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Facilitates the understanding of work capabilities and restrictions relevant for job placement.
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Promotes a structured return-to-work plan, enhancing recovery and productivity.
Eligibility Criteria for Completing the Physician's Return-to-Work & Voucher Report
Certain conditions dictate who is qualified to complete this form. Only applicable physicians, including primary treating physicians, Agreed Medical Evaluators, or Qualified Medical Evaluators, may fill out the report when the injury has been classified as permanent and stationary.
It is essential that the injury be assessed for permanent partial disability to ensure accurate evaluations and recommendations provided in the report.
Key Features and Components of the Physician's Return-to-Work & Voucher Report
This report contains specific fields and instructions that make it stand out. Essential fields include 'Employee Last Name', 'Date of Injury', and sections for assessing job compatibility against the employee's work restrictions.
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Clear layout with designated fields for personal and injury details.
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Instructions aiding physicians on conducting work capacity evaluations.
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Checkboxes and sections that help evaluate activity restrictions.
How to Fill Out the Physician's Return-to-Work & Voucher Report Online
To complete the report electronically, follow these steps. First, access the form on pdfFiller's platform, which offers a user-friendly interface for filling out forms.
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Log in or create an account on pdfFiller.
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Locate the Physician's Return-to-Work & Voucher Report.
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Fill out the necessary fields with accurate information.
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Utilize tools available for editing and annotating your responses.
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eSign the document when completed.
Submission Procedures for the Physician's Return-to-Work & Voucher Report
To submit the completed form correctly, various methods are available, including mailing, in-person delivery, or electronic submission. It is vital to be aware of relevant deadlines to avoid late submissions.
Additionally, users should confirm any applicable fees associated with submitting the report through their chosen method.
Common Mistakes to Avoid When Completing the Physician's Return-to-Work & Voucher Report
Accurate completion of this report is essential. Common errors can lead to complications or delays in processing. It is crucial to pay close attention to detail to avoid incomplete or incorrect information.
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Make sure all required fields are filled out accurately.
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Ensure proper physician signatures are affixed where necessary.
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Double-check information before submission to catch any mistakes.
Security and Compliance When Handling the Physician's Return-to-Work & Voucher Report
Handling sensitive health information demands strict adherence to data privacy regulations. pdfFiller employs robust security features, including encryption and compliance with HIPAA and GDPR, ensuring that user documents are secure.
Users can trust pdfFiller with their documents’ confidentiality, prioritizing security during all stages of form completion and submission.
Final Steps After Completing the Physician's Return-to-Work & Voucher Report
Once submitted, tracking the application status is essential to ensure all requirements are met. Users should understand the protocols for amending or correcting the form if necessary.
Additionally, recognizing what to expect in terms of feedback from the employer or claims administrator can help manage any subsequent steps in the process.
Get Started with pdfFiller for the Physician's Return-to-Work & Voucher Report
Utilizing pdfFiller's capabilities allows for a streamlined experience in handling forms online. Users can fill out the Physician's Return-to-Work & Voucher Report conveniently through any browser, without any downloads required.
Exploring related features like eSignature and form sharing can also enhance the management of documents within pdfFiller's platform.
How to fill out the CA Form 1013336
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1.To begin using pdfFiller, access the platform and search for the Physician's Return-to-Work & Voucher Report by its official name or document type.
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2.Once you locate the form, click on it to open and begin filling it out. Familiarize yourself with the layout and available fields in pdfFiller's interface.
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3.Before you fill in the fields, gather the necessary information such as the employee's details, claims administrator's information, and the specifics of their injury.
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4.Start completing the form by entering the employee's last name and first name, followed by the date of injury. Ensure accuracy as this information is essential for processing.
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5.Navigate to the claims administrator and employer name fields and input the respective details. These contacts are crucial for communication about the employee's status.
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6.Complete the work capacity evaluation section, carefully assessing and documenting the employee's restrictions and capabilities as they relate to the provided job description.
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7.Make sure you fill in the physician's signature field at the end of the form to validate the report. This is mandatory for the form’s acceptance.
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8.After filling out all relevant fields, take a moment to review the entire document for any errors or missing information.
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9.Once you are satisfied with the completed form, utilize pdfFiller's options to save your document by choosing a filename and location that is easy to remember.
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10.You can download the finished form to your computer or directly submit it through pdfFiller if required, ensuring it reaches the intended recipient.
Who is required to complete the Physician's Return-to-Work & Voucher Report?
Only the primary treating physician, Agreed Medical Evaluator, or Qualified Medical Evaluator can complete this form to ensure accurate evaluations of the employee's work capacity.
What is the time frame for submitting the report?
The report should be submitted as soon as the employee's condition is deemed permanent and stationary, ideally within 30 days of evaluation to avoid delays in the claims process.
Where can I submit the completed form?
The completed Physician's Return-to-Work & Voucher Report can be submitted to the employee's employer, claims administrator, or kept for the employee’s records as needed.
What information is required to fill out the report?
You will need the employee's full name, date of injury, employer's name, claims administrator details, and any pertinent medical evaluations or work restrictions specific to the employee.
Are there any common mistakes to watch for when filling out this form?
Common mistakes include omitting crucial information like the physician’s signature, inaccuracies in employee or injury details, and failing to meet submission timelines.
Is there a fee for processing this form?
Typically, there is no fee directly associated with filling out the Physician's Return-to-Work & Voucher Report itself; however, fees may apply during the claims process for related services.
What should I do if I need to make changes after submitting?
If changes need to be made after submission, contact the employer or claims administrator promptly to discuss the amendments and ensure the proper updates are documented.
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