Latest Resources Forms from Continuum Demo

Employee Expense Submission

Tue, 30 May 2017 18:19:31 +0100

Order documents from L&I Warehouse

Thu, 01 Jan 1970 03:00:00 +0100

s Activity Prescription Form (APF) (English)

Thu, 01 Jan 1970 03:00:00 +0100

Activity Prescription Form (APF)

Billing Code: 1073M (Guidance on back)

Reminder: Send chart notes and reports to L&I or SIE/TPA as required. Complete this form only when there are changes in medical status or capacities, or change in release for work status.

State Fund Claim:

Department of Labor and Industries

PO Box 44291 Olympia WA 98504-4291

Fax to claim file: 360-902-4567

Self-Insured Claims:

Contact the Self Insured Employer (SIE)/Third Party Administrator (TPA)

For a list of SIE/TPAs, go to www.Lni.wa.gov/SelfInsured

Discuss your patient’s role in their recovery

Research has shown that returning to activity (including lighter work) speeds recovery and reduces the risk of becoming disabled from most work-injuries. In addition to providing good clinical care, it is important to setexpectations for a good recovery and assure patients understand the importance of doing their part. Take just a couple minutes during an initial office visit to explain the following (check each one as you complete it):

Key Messages

1. “You must help in your own recovery…

”Only you can ensure your own successful recovery.
It’s your job (and my expectation) that you follow activity recommendations (both at home and at work).

2. “Activity helps recovery…”

Bodies heal best with activity that you can safely do, and need to do, to recover.
Incrementally increase the activity you do a little bit, each day.
Some discomfort is normal when returning to activities after an injury. This is not harmful, and is different from pain that indicates a setback.

3. “Early and safe return to work makes sense…”

Return to work is one of the goals of treatment.The longer you are off work, the harder it is to get back to your original job and wages.
Even a short time off work takes money out of your pocket because time loss payments do not pay your full wage.

Employee W4 Form - eSign

Thu, 12 Jul 2018 19:42:09 +0100

Form W-4 (2015)

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2015 expires February 16, 2016. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends)

Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee:

• Is age 65 or older,

• Is blind, or

• Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return.

The exceptions do not apply to supplemental wages greater than $1,000,000.

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations. Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.