APFActivity Prescription Form
Issued by Washington State Department of Labor & Industries (L&I)
Activity Prescription Form (APF) — 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
- Initial treatment encounter (Report of Accident); ongoing treatment encounters where work status and activity restrictions are assessed; changes in work capacity or restrictions; maximum medical improvement determination (RCW 51.28.010, WAC 296-20).
- Who fills it out
- Treating physician of record. Washington allows ARNPs (Advanced Registered Nurse Practitioners) to serve as attending providers for workers' compensation claims (RCW 51.36.010). PAs may treat under supervising physician. ARNPs may sign reports and APFs.
- Who signs
- Washington allows ARNPs (Advanced Registered Nurse Practitioners) to serve as attending providers for workers' compensation claims (RCW 51.36.010). PAs may treat under supervising physician. ARNPs may sign reports and APFs.
- Where it goes
- Activity Prescription Form (APF): at each treatment encounter where activity/work restrictions are addressed. Provider's Initial Report (PIR): filed with L&I upon first treatment. Progress reports required at treatment intervals. L&I may request additional reports.
- Electronic submission
- Supported — Washington L&I provides COHE (Centers for Occupational Health & Education) online tools and secure provider portal (My L&I) for electronic claim and report submission.
- Narrative substitution
- APF is the standard tool for communicating activity restrictions but is designed as a provider-communication tool; narrative chart notes/office notes documenting work status and restrictions may supplement. L&I may accept provider narrative for claim proceedings.
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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
Washington L&I
Statute
RCW 51 (Industrial Insurance)
Regulation
WAC 296-20 (Medical Aid Rules)
Form library
L&I APF Form
Attribution. Researched and maintained in collaboration with the wc-hub workers’ compensation reporting project (WA). BlueHive does not modify the underlying government PDF; the file you download is the agency original.
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