PHYSICIAN/HEALTH CARE

Use this subtask to enter detailed information about the physician and/or healthcare facility, if required for this case record.

Update this subtask whenever an employee has been injured in a work-related accident or reports an illness caused by working conditions.

Employee

This field displays the ID number and name of the employee for whom you are recording an accident or illness. This non-editable information defaults from the main screen.

Internal Case Number

This field displays the internal case number assigned to this record in the main screen.

Physician/HealthCare Info

Use this group box to add information regarding the physician and/or healthcare facility.

Employee Treated in Emergency Room

Select this checkbox if the employee was treated for the injury/illness in the emergency room. This information is requested in the OSHA 301 Form.

Employee Hospitalized Overnight as an Inpatient

Select this checkbox if the employee was hospitalized overnight as an inpatient. This information is requested in the OSHA 301 Form.

Physician

Use the fields in this group box to record the name and address information for the attending physician.

Name

Enter the name of the attending physician in this optional field, using up to 25 alphanumeric characters.

Address

Enter up to 30 alphanumeric characters for the street portion of the attending physician's address in this optional field.

City

For the city portion of the attending physician's address, enter up to 25 alphanumeric characters in this optional field.

State/Province

Enter, or use Lookup to select, the code for the state/province portion of the physician's address. State/province codes can contain up to 15 alphanumeric characters and are validated against the system's State table. This is an optional field.

Postal Code

Enter up to 10 alphanumeric characters for the zip code or foreign postal code portion of the attending physician's address. This field is optional.

Hospital

Use group box to record name and address information for the facility treating the employee's injury or illness.

Name

In this optional field, enter up to 25 alphanumeric characters for the name of the treating facility.

Address

Enter up to 30 alphanumeric characters for the street portion of the facility's address in this optional field.

City

Enter up to 15 alphanumeric characters for the city portion of the facility's address in this optional field.

State/Province

Enter, or use Lookup to select, the code for the state/province portion of the treating facility's address. State/province codes can contain up to 15 alphanumeric characters and are validated against the system's State table. This is an optional field.

Postal Code

Enter up to 10 alphanumeric characters for the zip code or foreign postal code portion of the facility's address in this optional field.