MEDCO-14 (BWC-3914)Physician's Report of Work Ability
Issued by Ohio Bureau of Workers' Compensation (BWC)
Physician's Report of Work Ability (MEDCO-14 (BWC-3914)) — equivalent or narrative-based clinician report used by the state workers’ comp agency.
Key facts
Clinicians fill out · Submitted to regulator · Employers file
- When it’s used
- Every injured-worker encounter (unless enumerated exceptions apply)
- Who fills it out
- Treating physician of record. NP/PA certification of temporary disability limited to first six weeks; later periods require physician co-signature
- Who signs
- NP/PA certification of temporary disability limited to first six weeks; later periods require physician co-signature
- Where it goes
- Every encounter
- Electronic submission
- Status unspecified — Routing depends on state-fund vs self-insured (fax to MCO vs employer)
- Narrative substitution
- Equivalent physician-generated document acceptable if it contains required data elements
Form preview
The official PDF is embedded below. If your browser does not render PDFs inline, download the file using the link above.
Preview the PDF without leaving the page.
Sources & citations
Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.
Issuing agency
Ohio BWC
VerifiedOpenStatute
ORC §4123 (Workers' Comp)
Attribution. Researched and maintained in collaboration with the wc-hub workers’ compensation reporting project (OH). BlueHive does not modify the underlying government PDF; the file you download is the agency original.
Need a provider who can complete this form?
BlueHive’s coordination network handles the services this form ties into. Each service page lists the providers in our network who routinely complete it.
Fitness for Duty Evaluation
When an employee incident raises safety questions, you need a clear, defensible fitness-for-duty determination — not weeks of back-and-forth with a local clinic. Through BlueHive, employers can connect with board-certified occupational physicians who deliver ADA-compliant FFD evaluations in days, not weeks.
Find a providerReturn-to-Work Evaluation
Every day an employee stays out of work costs you productivity, morale, and workers' comp exposure. BlueHive's return-to-work evaluations get employees back safely and quickly — with clear restrictions, accommodation guidance, and documentation your legal team can rely on.
Find a provider
Important Legal Notice
The regulatory information presented on BlueHive Compliance Watch is provided for general informational purposes only and should not be construed as legal advice. While we strive to maintain accurate and up-to-date information, regulations can change rapidly and may be subject to interpretation.
You should always:
- Consult with qualified legal counsel before making compliance decisions
- Verify information with official government sources
- Review the full text of any regulation cited herein
- Consider jurisdiction-specific requirements that may apply to your organization
BlueHive Health, LLC makes no warranties or representations about the accuracy, completeness, or timeliness of this information. We are not responsible for any actions taken or not taken based on this content.
Need help completing this form?
BlueHive coordinates the visit, captures the signed form, and routes it to the right destination — across DOT, USCG, workers' comp, and more.