Nurse Case Management Coordination Log

Documents communication and care coordination among the adjuster, treating provider, and injured worker for a workers' compensation claim.

Log Overview

• Log Date
• Claim Number
• Type of Coordination
• Participants Involved
• Summary of Contact
  Briefly describe the purpose of the communication and the key points discussed. Avoid unnecessary PII.

Treatment Status Update

• Current Treatment Status
• Treatment Setting
• Barriers to Recovery
• Barrier Details

Communication and Actions

• Treating Provider Contacted?
• Injured Worker Contacted?
• Adjuster Updated?
• Action Items

Return-to-Work Planning

• Work Status
• Restrictions Discussed
• Target Return-to-Work Date
• Return-to-Work Notes

Follow-Up and Consent

• Follow-Up Required?
• Follow-Up Date
• Consent / Disclosure Acknowledgment
  Confirm that information shared in this log is limited to the minimum necessary for claim coordination and is documented according to applicable privacy and consent requirements.
• Additional Notes