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Initial Workman’s Compensation Visit Form Mobile App

The Initial Workman’s Compensation Visit Form mobile app is designed to make documenting the first visit of someone injured on the job easy to complete using a mobile device. The app charts the initial compensation visit noting date and time of injury, location and place, date last worked, witnesses, reporting to employer, pain level, disability level, plan for returning to work and SOAP notes. Remember you device needs to validate your credentials against the server.

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  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Initial Workman’s Compensation Visit Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date of injury:

  • Ico time

    Time of injury:

  • Ico textbox

    Employer:

  • Ico textbox

    Place:

  • Ico date

    Date last worked:

  • Ico multiline

    What were you doing?

  • Ico multiline

    Was it witnessed?

  • Ico multiline

    Have you filed a report with the employer?

  • Ico multiline

    Have you seen another doctor / gone to the Emergency Department for this injury?

  • Ico multiline

    What is wrong now / Where do you have pain?

  • Ico dropdown

    Have you ever had a similar injury?

  • Ico multiline

    If yes, when and what happened?

  • Ico date

    When do you plan to return to work?

  • Ico multiline

    S:

  • Ico multiline

    O:

  • Ico multiline

    A:

  • Ico multiline

    P:

  • Ico dropdown

    From injury to present:

  • Ico dropdown

    From now:

  • Ico date

    RTW date:

  • Ico multiline

    Restrictions:

  • Ico date

    Recheck:

  • Ico signature

    MD

  • ...and More!

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More Information


  • Creator: Team GoCanvas
  • Language: English
  • Country: United States of America
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