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Worker's Comp Dictation Format
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Employer:
Position:
Date of Injury:
Date of First Examination:
 
17.      History: How did it happen?
18.      Subjective Complaints: Complains of... Acute onset;  accumulative
           type injury; aggravation of; pre-existing
19.a.   Physical Exam:
19.b.  Tests required.
20.     Diagnosis:
21.     Affirmative (findings consistent with the patient's account of the injury)
22.     Negative (anything to impede recovery)
23.     Treatment rendered:
         "The patient was evaluated and the following treatment was
          recommended in conjunction with Dr.___"  Anticipated follow-up days
          with OT/PT along with re-eval.
24.      Hospitalization is not required.
25.      Work Status:
           "The following work limitations and disability states were determined
             by Dr. ______."
           Who was notified and time of notification.