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Form CA-16: Instructions. Form CA-16: Information for Physician. Form CA-16: Chain of Referral. Original treating physician may wish to refer employee for additional testing or specialized treatment. Physician may do so on basis of Form CA-16 already issued.
11 lip 2023 · The supervisor shall immediately authorize examination and appropriate medical care by use of Form CA-16 issued to either a United States medical office or hospital or any duly qualified physician/ hospital of the employee's choice.
Please read Part A of Form CA-16. You are authorized to examine and provide treatment for the injury or disease described in Item 5, for a period of not more than 60 days from the date of issuance, subject to the conditions in Item 6.
Authorized employing agency users of the Agency Query System (AQS) may access an electronic version of the CA-16 for download through the AQS website. If Form CA-1 is electronically filed via ECOMP, employing agency users may obtain a copy of Form CA-16 in electronic format after completing the supervisor review step.
If an employee, in an emergency situation has to be sent and/or admitted to an Acute Care Facility for emergency surgery or care, a copy of the OWCP Uniformed Billing Form (UB-04-1450) should be supplied together with the submitted Form CA-16.
If the employer doubts that the injury occurred, or that it is work-related, he or she should authorize medical care by completing Form CA-16 and checking block 6B of the form.
20 CFR 10.300 – You Have a Right to a CA-16. When an employee sustains a work-related traumatic injury that requires medical examination, medical treatment, or both, the employer shall authorize such examination and/or treatment by issuing a Form CA-16. This form may be used for occupational disease or illness only if the employer has ...
