COHE Forms & Resource Links

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Activity Prescriptions Form  

 

L&I Activity Prescription Form

The APF is to be completed by the COHE provider on initial and follow-up visit when the injured worker has not returned to full duty. Completion of this form allows COHE providers to receive enhanced fees using billing code 1073M   

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COHE Clinic Job Aid  

 

COHE Process Job Aid (Clinic)

An efficient job aid for providers, support staff, medical records, billing and administrators as a quick glance guide describing each step of the Occupational Health Best Practices in a clinic setting 

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  COHE Clinic Job Aid  

 

COHE Process Job Aid (Emergency Department)

An efficient job aid for providers, support staff, medical records, billing and administrators as a quick glance guide describing each step of the Occupational Health Best Practices in a ED setting. 

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Employer Job Description Form

L&I Form to be completed by employer of record to describe tasks and physical demands for restricted/modified duty jobs to facilitate return-to-work. Provider completes second page when presented by employer, employer representative, Claim Manager, or Vocational Rehabilitation Counselor 

 

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COHE Letter of Intent

This form is to be completed as a statement of interest in MDs, DOs, DCs, ARNPs, and PACs that would like to participate in COHE.  Completed forms should be faxed to the COHE office at 866-853-0137. 


 

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Impediments to Return to Work Guide  

Impediments to Return-to-Work Guide

Providers use the checklist as a guide to assist in evaluation of patients who are at risk of long term disability, on time loss, or when a light duty Return-to-Work (RTW) attempt was not successful.


  WA Department of Labor and Industries    

Department of Labor and Industries

Official website of the Washington State Department of Labor & Industries.  Access information regarding all aspects of the Department for businesses, workers and medical providers, including locating a provider approved in the Medical Provider Network, FileFast, ordering L&I forms and completing forms online. 

 
       
       
  Claim and ACcounts Center     

Claims and Accounts Center (SAW)

Secure Access Washington is a single sign-on application gateway that allows you to access multiple online government services including Claims and Accounts Center (CAC) to review injured worker claims. 

 

 
COHE Fee Schedule  

COHE Program Fee Schedule - July  2015

This document is a guide and not a comprehensive, stand-alone reference for documentation and billing requirements. For complete information, please refer to the L&I Medical Aid Rules and Fee Schedules.

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