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Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

Scale of Fees

Annual Increase in Medical Tariffs for Medical Service Providers - 2020

Occupational Therapy

Rehabilitation Progress Report


Claim Number: .............................


Rehabilitation Progress Report

Compensation for Occupational Injuries and Diseases Act


Names and Surname of Employee                                                                                                                              

Identity Number                                                   Address                                                                                            

                                                                                                                Postal Code                                                          

Name of Employer                                                                                                                                                              


                                                                                                                Postal Code                                                          

Date of Accident                                                            


1. Date of first treatment                             Provider who provided first treatment                   __
2. Initial clinical presentation and functional status                                                                         ____



3. Name of referring medical practitioner                                     Date of referral                   _____
4. Describe patient's current symptoms and functional status                                                          __




5. Are there any complicating factors that may prolong rehabilitation or delay recovery (specify)?




6. Overall goal of treatment:                                                                                                                           __



7.        Number of sessions already delivered                  Progress achieved                                   _____





8.        Number of sessions required            __      Treatment plan for proposed treatment sessions



9.        From what date has the employee been fit for his/her normal work?                            ______

10. Is the employee fully rehabilitated/has the employee obtained the highest level of function?


11. If so, describe in detail any present permanent anatomical defect and/or impairment of function as a result of the accident (R.O.M, if any must be indicated in degrees at each specific joint)






I certify that I have by examination, satisfied myself that the injury(ies) are as a result of the accident.



Signature of rehabilitation service provider                                                                                                 _____

Name (Printed)                                                                     Date (Important)                                                   ___

Address                                                                                                                                                                                   _

Practice number                                                                    


N.B.  Rehabilitation progress reports must be submitted on a monthly basis and attached to the submitted accounts.