Medical Status Form
MCA 39-71-1036 Requires that the treating physician or a designee complete the medical status form following every office visit with the injured worker. The legislature directed the Department to create a form to be used for individuals with occupational injuries or occupational diseases. The Department offers three fillable versions of the form which meet the minimum statutory requirements. Select and download one of the following versions to complete following each office visit.
Form Version 1 Form Version 2 Form Version 3
The Department would like your feedback on how the Medical Status Form updates are working in the system. Please take a moment to answer this short, 5-question survey: How are the Medical Status Form updates working in the system?
If you have questions about the use of the Medical Status Form, you may email Celeste Ackerman at celeste.ackerman@mt.gov or call (406) 444-6604.