N.H. Admin. Code § Lab 508.01 - Medical Reports
(a) A "Workers' Compensation Initial Medical
Report,", form 75WCA-1 (6/1994), contained in Appendix II, shall be completed
in full and filed with the carrier within 10 days of the first examination. The
health care provider shall keep a supply of the initial medical report form in
their offices for completion. If an injured employee is released to return to
work, the medical report form shall indicate whether the employee can resume
his or her former duties or perform light or other work.
(b) There shall be no reimbursement for
services rendered upon the failure of the practitioner to provide the carrier
with the "Workers Compensation Initial Medical Report", 75WCA-1(6/1994),
contained in Appendix II within 10 days of the first treatment. Furthermore,
the failure of practitioner to provide the carrier with medical information
necessary in the prompt processing of a claim, may result in the nonpayment of
the medical bill under RSA 281-A:23V(c).
(c) Medical reports submitted in conjunction
with assessment of permanent bodily loss under
RSA
281-A:32 shall contain affirmation that the
findings were determined from Guide to the Evaluation of Permanent
Impairment, 5th edition, published by
the American Medical Association available as noted in appendix III.
Notes
(See Revision Note at part heading for Lab 508) #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED: 3-16-98
New. #6806, eff 7-18-98 (formerly Lab 507.01); ss by #8682, INTERIM, eff 7-15-06, EXPIRED: 1-11-07'
New. #9019, eff 11-1-07
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