1. What initial form must be 100% complete for each new patient?
2. Which form is used for an injury that happened in a single work shift?
3. Which form is used for an injury that happened over 2 or more work shifts?
4. Which form is used to take a patient off work or give work restrictions?
5. Which form is used to allow patients to get exam and treatment in the first 60 days?
6. What form does a patient need to fill out to get paid after 45 days?
7. What form does a patient submit to get paid with their schedule award?
8. Which form is used when a patient reports a recurrence of a past injury?
9. Which form is used for patients to be reimbursed for mileage?
10. Which form is used for patients to be reimbursed for past medical expenses?
11. What form is used for patients to be paid while they are getting treatment?
12. For a CA1 injury, preauthorization for therapy is not required in the first _______ days after the DOI.
13. T or F – After the time period in question 23 above, preauthorization for some therapy services can still be done without preauthorization.
14. DOL sends all letters and other correspondence regarding a patient’s case to:
The patient’s residence.The doctor’s office.The patient’s designated representative.Nowhere. It’s all online.
15. T or F – It is the Case Managers responsibility to keep track of billing and revenue.
16. When should the patient’s initial history and physical narrative be uploaded to DOL once it is complete?
17. T or F – The Case Manager is involved in making medical decisions for injured patiens.