Activity Prescription Form


The Activity Prescription Form is a powerful communication tool

L&I considers the effective use of the Activity Prescription Form (APF) as a best practice in occupational medicine. The form communicates an injured worker's physical restrictions and ability to work as well as the provider's treatment plans. In addition, workers' time-loss benefits depend on the APF and your chart notes.

What employers can ask

Employers can contact the attending provider to clarify physical capacities related to returning to work. However, employers can't ask a provider to complete an APF. (L&I does not pay for APFs completed at the request of employers or attorneys.)

Employers can also ask providers for:

    • Concurrence with a performance-based physical capacities evaluation (PBPCE).
    • Authorization for a worker to participate in a PBPCE.
    • Approval of job descriptions or job analyses.

Using standard forms and limiting the information needed for the request and approval improves turn around and communication.

You can remind employers to review the completed APFs that are a part of the worker's claim file in the Claim & Account Center.Secure


Call the Provider Hotline 1-800-848-0811 with your questions about the APF.

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