{"data":{"id":"us-mt/39-71-1036","jurisdiction":"us-mt","citation":"39-71-1036","heading":"Medical status form.","body":"(1) The department shall create a medical status form to be provided to a health care provider providing treatment for a compensable injury or occupational disease.\n(2) The form must contain, at a minimum, the following information:\n(a) the worker's first and last names and claim number;\n(b) the affected body part that is directly related to the compensable injury or occupational disease;\n(c) the timeframe during which the treating physician recommends that the worker be completely off work;\n(d) the date or anticipated date of the worker's release to modified duty;\n(e) the date or anticipated date of the worker's release to full duty;\n(f) any temporary work restrictions applicable to the worker;\n(g) any permanent work restrictions applicable to the worker; and\n(h) the date of the worker's next appointment.\n(3) An insurer may request additional information from the health care provider not contained in the department's form.\n(4) The treating physician or a designee shall complete the form following every office visit with the worker.","path":["TITLE 39. LABOR","CHAPTER 71. WORKERS' COMPENSATION","Part 10. Stay-at-Work/Return-to-Work Assistance"],"source_url":"https://mca.legmt.gov/bills/mca/title_0390/chapter_0710/part_0100/section_0360/0390-0710-0100-0360.html","current_through":"Montana Code Annotated 2025","vintage":"","retrieved_at":"2026-09-14T04:54:42Z","sha256":"31297d5b7a84f88ad49beaff7a06a89fcfff8fc3f2f206efcd551c1102cde521","source_id":"us-mt","stale":false,"prev":"us-mt/39-71-1034","next":"us-mt/39-71-1037"},"notice":"GroundRules: Original legal text. Not legal advice."}