Web Content Viewer
Web Content Viewer
MEDCO-14 information
MEDCO-14 form for work restrictions, accommodations, or temporary total disability

The physician must complete this standard form, when placing the injured worker under work restrictions, requiring accommodations or indicating he or she is temporarily totally disabled. Use the Physicians’ Report of Work Ability (MEDCO-14) during evaluation, re-evaluation and management services. This is usually every 30 days.

The MEDCO-14 is similar to forms managed care organizations (MCOs) or physician offices use and provides a permanent record for the physician's file. Fax a copy to the appropriate MCO or self-insuring employer. This will help employers know their injured workers’ restrictions and explore work site adaptations/modifications. Provide a copy to the injured worker at the time of the visit.

The MEDCO-14 also contains:

  • Information about to whom the form was faxed and where.
  • Space for the physician's name stamp.
  • Easy check-off boxes about the work/non-work capabilities, physician instructions, whether the injured worker is temporarily totally disabled, a request for vocational rehabilitation services, and the date and time of his or her next appointment.

This form reduces the need for phone calls among the parties to the claim about the injured worker's return-to-work progress, and provides important information to injured workers about their recovery and work limitations. Injured workers have immediate information they can share with their supervisors when they return to the job.

In addition, employers will see the progress of their injured workers from the beginning of treatment until they are back on the job, and they will be able to assist in successful return-to-work practices.