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This version of the form is not currently in use and is provided for reference only. Download this version of
Form LS-204
for the current year.
Form LS-204 Attending Physician's Supplementary Report
What Is Form LS-204?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 1, 2012 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form LS-204?A: Form LS-204 is the Attending Physician's Supplementary Report.
Q: Who should complete Form LS-204?A: The attending physician should complete Form LS-204.
Q: What is the purpose of Form LS-204?A: The purpose of Form LS-204 is to provide additional medical information or updates related to a worker's injury or illness.
Q: Are there any deadlines for submitting Form LS-204?A: The deadlines for submitting Form LS-204 may vary depending on the regulations of the workers' compensation agency. It is important to check the specific deadlines for your jurisdiction.
Q: Is completing Form LS-204 mandatory?A: The requirement to complete Form LS-204 may vary depending on the regulations of the workers' compensation agency. It is important to check the specific requirements for your jurisdiction.
Q: What information should be included in Form LS-204?A: Form LS-204 typically includes information about the worker's diagnosis, treatment plan, estimated return-to-work date, and any restrictions or limitations.
Q: Can Form LS-204 be used for both work-related injuries and illnesses?A: Yes, Form LS-204 can be used for both work-related injuries and illnesses.
Q: Is Form LS-204 confidential?A: The confidentiality of Form LS-204 may vary depending on the regulations of the workers' compensation agency. It is important to check the privacy and confidentiality policies of your jurisdiction.
Q: Can Form LS-204 be used for ongoing medical updates?A: Yes, Form LS-204 can be used to provide ongoing medical updates as necessary.
Q: Is there a fee for submitting Form LS-204?A: The fee requirements for submitting Form LS-204 may vary depending on the regulations of the workers' compensation agency. It is important to check the fee schedule for your jurisdiction.
Form Details:
- Released on April 1, 2012;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form LS-204 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form LS-204 Attending Physician's Supplementary Report
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