DEP Physicians Report Of Work Ability Cognitive Psychological {BWC-1270 PC}

BWC-1270 - DISABILITY EVALUATOR PANEL (DEP) PHYSICIAN’S REPORT OF WORK ABILITY COGNITIVE/PSYCHOLOGICAL CONDITIONS. This form is used by the Ohio Bureau of Workers' Compensation for physicians on the Disability Evaluator Panel (DEP) to assess and report an injured worker's work abilities concerning cognitive and psychological conditions. The physician evaluates and classifies the worker’s functional limitations based on clinical observations and test results. These evaluations include restrictions on activities of daily living, social functions, thinking, concentration, judgment, and stress adaptation. The form categorizes restriction severity into five classes, ranging from no restrictions to restrictions that preclude all functioning. The physician specifies the worker’s ability to perform specific tasks, determines whether the restrictions are temporary or permanent, and provides the expected duration if temporary. The form also asks for a summary of work abilities, especially for moderate to severe limitations, and calculates how many hours and days the injured worker can work. C-143 PC. www.FormsWorkflow.com