Clinical Tools

Uniform Workability Report Form

Mid-America Coalition on Health Care- Uniform Workability Report Form

The Uniform Workability Report Form was designed by employers and physicians as a part of the Mid-America Coalition of Health Care's project entitled Community Based Collaborative Approach to Improving Workers' Compensation Medical Care. It was used as a communications tool as well as a data collection tool. The form provides essential management information concerning the health status of the injured worker after each physician visit. The form contains most of what an employer needs to know in order to make effective management decisions about managing an employee's absence, the injured worker's potential for return to work, treatment plans offered, referrals made, work activity restrictions, and date of return visits to the physician.