Form AR-3 – Physician’s Report

Jurisdiction: Country: United States | Province or State: Arkansas

What is a Form AR-3 – Physician’s Report?

Form AR-3 is the standard physician’s report used in Arkansas work injury claims. It captures the treating doctor’s medical findings, work status, and treatment plan. The form helps everyone involved understand the injury and the next steps. It supports decisions on benefits, care, and return-to-work.

You use this form any time a work injury needs medical documentation. It records the diagnosis, objective findings, and any functional limits. It also states when you can return to work and on what terms. The form becomes part of the official claim file.

Who typically uses this form?

Treating physicians and clinics complete and submit it. Employers and insurance adjusters request it and rely on it. Injured workers read it to see their status and plan. Case managers and legal representatives use it to coordinate care and benefits.

Why would you need this form?

Because benefits often depend on it. Payment of medical bills needs clear medical support. Wage-loss benefits require a doctor’s off‑work order or restrictions. Employers need restrictions to place you in a light‑duty role. The form answers these questions in one place.

Typical usage scenarios include the first medical visit after an injury. You also use it after surgery, when restrictions change, or when you reach maximum medical improvement. If you move from no work to light duty, you use it. If you finish therapy and face permanent limits, you use it. If you need a referral or advanced imaging, you use it. The form communicates that status change to all parties.

The form is concise but structured. It asks for claim identifiers, injury details, and clinical findings. It requires a clear work status and a follow‑up plan. It also asks for the physician’s signature and credentials. That signature certifies the accuracy of the medical statements.

Think of the AR-3 as a medical and administrative bridge. It ties clinical care to the benefits system. It helps speed approvals and reduce confusion. It helps you avoid missed pay or delayed authorizations.

When Would You Use a Form AR-3 – Physician’s Report?

• You use this form right after the first evaluation. The doctor documents the injury, early findings, and initial restrictions. This first report sets the tone for the claim. It can help start wage‑loss benefits if you need time off.
• You use it again when anything significant changes. For example, the doctor moves you from off‑work to light duty. Or you complete a therapy phase and have new strength scores. Or imaging confirms a tear that needs surgery. You also use it when your restrictions lift.
• If you have surgery, the form updates your status. It lists post‑operative limits and the next review date. It notes when you can progress in therapy. It sets safe duty limits and timelines for work trials.
• When you near the end of healing, the form matters again. The doctor notes whether you reached maximum medical improvement. If you did, the doctor states that you have a permanent impairment. The doctor sets any permanent restrictions. Those details help with benefit closure and work planning.
• As a physician, you use the form to document your opinions. You set out causation, diagnosis, and treatment rationale. You define work capacity in a clear format. You provide target dates and follow‑up plans.
• As an employer, you rely on the form to manage jobs. You identify tasks that fit the current restrictions. You can design transitional duty based on the limits listed. You can also plan staffing for coverage during recovery.
• As an adjuster or administrator, you use the form to authorize care. You set wage-loss benefits based on medical limits. You schedule nurse case management if needed. You decide if an independent review is necessary.
• As an injured worker, you track your status and next steps. You see what you can and cannot do at work. You learn how long the limits last. You also confirm any referrals or tests ahead.
• In a disputed claim, the form still plays a key role. It shows objective findings and notes diagnostic support. It can support or refute the alleged mechanism of injury. It can help a judge or mediator understand the medical picture.
• In short, you use the AR‑3 at the start, at each change, and at closure. It keeps the file current and the process moving.

Legal Characteristics of the Form AR-3 – Physician’s Report

The AR-3 is an official workers’ compensation form. It is not a private letter or a simple chart note. It carries legal weight because rules require it in work injury claims. The form becomes part of the claim record and can be used as evidence.

Is it legally binding?

It binds the physician to the statements made. The signature certifies that the findings are true and accurate. It does not bind parties to agree on benefits by itself. But it guides benefit decisions and return‑to‑work actions. It is considered reliable because it comes from the treating doctor.

What ensures enforceability?

The form requires key identifiers. It records the claim number, injury date, and employer. It requires the physician’s license information and signature. It states specific restrictions and effective dates. These details allow parties to rely on the document.

The form is strongest when it is complete and timely. Courts and administrators expect accurate, objective entries. Clear findings, measured limits, and diagnostic support increase weight. Vague entries reduce usefulness. Gaps can delay benefits or drive disputes.

Statements on causation are important. The doctor should address whether work caused or aggravated the condition. That opinion can influence compensability. It should be stated clearly and backed by findings and history.

Privacy laws still apply. The form contains protected health information. Only parties with a right to the file should receive it. Clinics should control access and follow secure delivery methods.

False statements carry consequences. Providers must report accurately, without exaggeration or minimization. Adjusters and employers should not alter the form. Any changes must come from the physician.

Retention rules apply. Keep copies in the medical record and claim file. Date and time stamps help show compliance with timelines. If the form is corrected, keep both versions with clear notes.

In summary, the AR‑3 is an official medical report within a legal claim. It supports benefit decisions and can be used in hearings. Accuracy, clarity, and timeliness drive its legal weight.

How to Fill Out a Form AR-3 – Physician’s Report

Step 1: Gather claim and contact information.

You need the worker’s name, date of birth, and address. Confirm the employer’s legal name and contact details. Capture the claim number if assigned. Note the insurer or administrator and adjuster contact. Verify the date of injury and body part involved. Having this upfront prevents mismatches and delays.

Step 2: Identify the treating provider.

Enter the physician’s full name and credentials. Include the clinic or facility name. Add the clinic address, phone, and fax. Include the physician’s license number and any national identifier. If billing requires a tax identifier, include it. This data ties the report to the right provider.

Step 3: Record the visit details.

List the date of examination and time if requested. Indicate whether this is the first report or an update. If it is an update, state what changed. For example, “restrictions revised after therapy.” This helps readers understand the context of the update.

Step 4: Document the mechanism of injury.

Describe how the injury occurred, in simple terms. Use the worker’s account and any known facts. Note the location, activity, and immediate symptoms. Keep it objective and concise. This helps with causation and claim acceptance.

Step 5: Describe the injury and body parts.

List the specific anatomical areas affected. Avoid vague phrases like “back issue.” State “lumbar strain” or “L4‑L5 disc herniation,” if known. If multiple areas are involved, list each one. Precision helps with care plans and job matching.

Step 6: Enter diagnoses and codes.

Provide the primary diagnosis and any secondary diagnoses. Include ICD codes if the form asks for them. Match codes to narrative descriptions. Align with your chart note and billing. Consistency reduces disputes.

Step 7: Summarize subjective complaints and history.

Briefly note pain location, quality, and severity. Include precipitating factors and prior issues if relevant. Document aggravating and relieving factors. Keep it concise. Focus on what affects work capacity and care.

Step 8: Record objective clinical findings.

Provide exam findings, tests, and measured limits. Include strength grades, range of motion, or neurologic signs. Attach imaging reports if available. Objective data increases trust in your conclusions. Avoid boilerplate wording.

Step 9: Outline treatment provided today.

List medications prescribed or adjusted. Note injections, splints, or wound care. Record therapy orders and home exercise plans. Mention any durable medical equipment. This shows the immediate course of care.

Step 10: Set the treatment plan.

Describe next steps and expected timelines. Include therapy frequency and duration. Identify pending imaging or specialist referrals. State medical necessity in plain language. Give a target date for reassessment.

Step 11: State the work status.

Choose one: full duty, restricted duty, or no work. If full duty, specify the return date. If restricted duty, list each restriction clearly. Use measurable limits. Examples include lifting limits, standing time, and overhead reach. Set a duration for the restrictions, such as “two weeks.” Give a follow-up date to review capacity.

Step 12: Clarify off‑work dates if needed.

If you direct no work, give start and end dates. Avoid open‑ended orders. Tie the time frame to recovery milestones. This helps wage-loss calculations and job planning.

Step 13: Address causation.

State whether the work incident caused or aggravated the condition. Explain your reasoning briefly. Link mechanism, timing, and findings. Be clear if the condition is unrelated. This section influences claim decisions.

Step 14: Note pre‑existing conditions or comorbidities.

Explain any conditions that affect recovery or capacity. Clarify baseline status versus new injury impact. If apportionment is relevant, outline your opinion. Keep it factual and neutral.

Step 15: Discuss maximum medical improvement when appropriate.

If you believe MMI is reached, say so and give the date. If not, estimate when you expect it. Explain what further recovery you expect. This guides benefit transitions and case closure.

Step 16: Provide impairment information if at MMI.

If the form asks, give a permanent impairment rating. Identify the body part and percent. Briefly describe how you calculated it. Attach supporting worksheets if required. Keep your method consistent with adopted guidelines.

Step 17: Identify referrals and authorizations.

List specialists, imaging, or procedures you request. Explain why the referral is needed. Provide urgency and target dates. Clear requests speed approvals.

Step 18: Add attachments.

Attach operative reports, imaging, and therapy notes if pertinent. Include work capacity forms if separate. Attach bills as required. Label attachments with the worker’s name and claim number.

Step 19: Sign and date the form.

Print your name and credentials. Add your signature and the date signed. Include your direct contact for questions. The signature certifies your statements.

Step 20: Distribute copies.

Send the form to the insurer or administrator. Provide a copy to the employer’s contact. Give a copy to the worker on request. File a copy with the state authority if required. Use secure and approved delivery methods.

Practical tips for accuracy

• Keep sentences short and specific.
• Use numbers for limits, not vague terms.
• Explain medical necessity in one or two lines.
• Set follow‑up dates and stick to them.
• Update the form with each status change.

Common mistakes to avoid

• Leaving work status blank. This delays decisions.
• Using “light duty” without details. List exact limits.
• Not listing the injury date. It ties the report to the claim.
• Conflicting narratives within the form. Keep it consistent.
• Missing signature or credentials. Unsigned forms carry less weight.

Examples help clarify

Example 1: A delivery driver strains a shoulder. First visit: diagnosis of rotator cuff strain. Restrictions: no lifting over 10 pounds with the right arm. No overhead reach with the right arm. Follow up in 10 days. The AR‑3 documents those limits. The employer assigns inside light duty.

Example 2: A technician has lumbar pain after lifting. After therapy, strength improves. The doctor updates the AR‑3. Restrictions change to lift 25 pounds occasionally, no ladders, and frequent position changes. A new follow‑up date is set. Wage‑loss benefits adjust based on the new capacity.

Example 3: A worker completes surgery and heals. The doctor finds maximum medical improvement. The AR‑3 notes MMI and a small permanent limit. The doctor rates a modest impairment and sets permanent limits. The employer offers a job within those limits. The claim moves toward closure.

If you are a clinic administrator, build a checklist. Capture claim number, injury date, and adjuster info up front. Verify employer name and correct spelling. Preload provider identifiers to avoid omissions. File and send on the same day you sign.

If you are an employer, request the AR‑3 after each visit. Match tasks to listed restrictions. Keep communication open with the adjuster. Plan schedules around follow‑up dates. Document offers of light duty.

If you are an injured worker, ask your doctor to complete the form. Bring it to visits if needed. Confirm your restrictions before you leave. Share any changes in your symptoms. Keep a copy for your records.

Timing matters. Submitting the AR‑3 within a few days keeps the benefits current. Delays can hold up checks and authorizations. Update the form after any change, not just at scheduled visits. Fast updates reduce friction across the claim.

Clarity wins. Write in plain language. Use measurable limits. Connect findings to decisions. Provide next steps and dates. The AR‑3 works best when it tells a complete and simple story.

Finally, treat the AR‑3 as a living document. It evolves as recovery progresses. Early reports may be cautious and time‑limited. Later reports refine restrictions and goals. The last report should leave no open questions. When a reader can see what happened and why, you have done it right.

Legal Terms You Might Encounter

• When you complete Form AR-3 – Physician’s Report, you will see “claim number.” This is the unique identifier assigned to the patient’s workers’ compensation claim. You need this number on every report so the insurer and state office can match your findings to the correct file. If you leave it blank or guess, your report can be misfiled or delayed.
• The “date of injury” anchors the entire claim. It ties clinical findings and treatment timelines to a specific event or exposure. Confirm this date with the patient and any available records. If you think the condition stems from cumulative exposure, explain the time frame. The report should connect your medical opinion to that date or period.
• “Mechanism of injury” describes how the incident occurred. This is not a legal statement; it is your medical understanding of the forces involved, such as a fall, twist, lifting event, or repetitive motion. Include a brief, clear description. The mechanism helps you explain why the diagnosed injury is consistent (or not) with the incident.
• “Body part” and “laterality” must be precise. List the affected anatomical region and side, such as “right shoulder” or “lumbar spine.” If multiple areas are involved, identify each one. Your diagnosis and treatment plan should align with the body parts you list on the form.
• “Objective findings” are measurable signs you observed or obtained, like range-of-motion deficits, strength testing results, neurological changes, swelling, or imaging results. These are different from the symptoms the patient reports. The form relies on objective findings to support work status, restrictions, and any impairment.
• “Subjective complaints” are the patient’s reported symptoms, including pain, numbness, or instability. Document them accurately, but avoid vague phrases alone. Pair subjective complaints with your objective findings when possible to build a complete clinical picture.
• “Causation” asks whether, in your medical opinion, the work incident or exposure caused or aggravated the condition. Use clear language such as “consistent with” or “more likely than not.” You do not have to resolve legal questions; you are offering a medical opinion based on history, exam, and diagnostics. If there are contributing non-work factors, explain them.
• “Work restrictions” are functional limits you recommend. They include lifting limits, standing or sitting tolerance, use of the injured limb, and any limits on driving, climbing, or repetitive motions. Be specific and add an effective date. If the patient cannot work at all, say so clearly and note the reason.
• “Temporary total disability (TTD)” describes a period when the patient cannot perform any job due to the injury and ongoing treatment. If you certify TTD, document the start date and your plan for reassessment. If the patient can work with restrictions, note that instead and define the limits.
• “Maximum medical improvement (MMI)” means the patient is medically stable. You do not expect a significant change with further usual treatment. The form often asks if the patient has reached MMI. If not, estimate a timeframe or the steps needed to reach stability. If yes, the report may also call for an “impairment rating.”
• An “impairment rating” is a percentage that reflects lasting loss of function after MMI. If you assign a rating, reference the clinical basis and the body part(s). Use consistent, recognized medical criteria. Attach measurements or exam details that support the rating.
• A “functional capacity evaluation (FCE)” is a structured assessment of physical abilities. You might reference an FCE when work capacity is unclear or disputed. If you rely on FCE results, summarize key findings and how they inform restrictions.
• “Authorized treating physician” refers to the physician recognized in the claim as responsible for directing care and providing official reports. If you are the authorized treating physician, your opinions on causation, restrictions, MMI, and impairment carry particular weight. If you are a consultant, say so, and confine your opinions to the scope of your exam.

FAQs

Do you need the patient’s signature on Form AR-3?

You usually do not need the patient’s signature on this form. The physician’s signature is required. If you attach clinic notes, imaging, or other records, ensure you have a valid patient authorization where needed. Follow your privacy policies for disclosures in workers’ compensation cases.

Do you complete a new Form AR-3 after every visit?

Complete a new report when there is a material change. That includes a new diagnosis, a change in work status, surgery or hospitalization, a significant test result, reaching MMI, or assigning an impairment rating. For routine visits without meaningful change, update the report at reasonable clinical intervals or as requested.

Do you attach imaging and test results?

You can attach concise summaries. Include key objective findings on the form itself. Attach longer reports only if they clarify complex findings or support impairment decisions. If attachments are included, label them with the patient name, claim number, and date.

What if you don’t know whether the condition is work-related yet?

Say that causation is undetermined and explain what you need to decide. That could include a more detailed history, prior records, additional diagnostics, or a follow-up exam. Give a timeline for when you expect to reach an opinion, and update the report when you do.

How do you report work status when the patient can do some tasks?

Use clear functional limits. For example, “No lifting over 15 pounds,” “No overhead reaching with the right arm,” or “Sit/stand as needed.” State whether these are temporary and when you will reassess. If the patient can work full duty, say so. If off work, specify why and for how long.

What if multiple injuries are involved?

List each body part and diagnosis. If the space on the form is not enough, attach a continuation page. Make sure each injury has related findings, restrictions, and a treatment plan. If one condition has reached MMI and another has not, separate your opinions for each.

Can you correct or update a Form AR-3 after submitting it?

Yes. Send a supplemental or amended report. Identify it as “Supplemental” or “Amended,” include the original report date, and describe what changed. Corrections should be prompt and precise. Keep a copy of both versions in the chart.

What happens if the report is late or incomplete?

Late or incomplete reports can delay wage replacement decisions, authorization for treatment, and payment of medical bills. Submit the form as soon as you can. If information is pending, file an initial report with what you know, note what is outstanding, and follow up with an update.

Checklist: Before, During, and After the Form AR-3 – Physician’s Report

Before signing

• Confirm the patient’s full name, date of birth, and contact details.
• Obtain the claim number, employer name, and insurer contact.
• Verify the date and mechanism of injury with the patient and available records.
• Gather current diagnoses, active problems, and relevant prior conditions.
• Compile objective findings: exam results, imaging summaries, and lab highlights.
• Review prior treatment: medications, therapy, injections, surgery, and hospital stays.
• Note current medications, allergies, and any contraindications.
• Get information on job duties and physical demands, if available.
• Decide on work status and specific restrictions supported by findings.
• Determine whether the patient is at MMI. If not, outline next steps and timeframe.
• If considering an impairment rating, gather measurements and support.
• Have your professional identifiers and clinic contact information ready.

During signing

• Verify patient identifiers and the claim number on every page or attachment.
• Check the date of injury and confirm it matches the history you relied on.
• State diagnoses clearly, with laterality and body part. Avoid unclear abbreviations.
• Document objective findings that support your opinions.
• Record the patient’s relevant subjective complaints without exaggeration.
• Provide a clear causation statement, even if provisional.
• Specify work status and functional restrictions with an effective date.
• Indicate TTD if the patient cannot work, and explain the medical reason.
• State whether the patient has reached MMI. If yes, give the date of the MMI.
• Assign an impairment rating only if appropriate and well supported.
• Outline the treatment plan, including referrals and anticipated follow-ups.
• Ensure your signature, printed name, license information, and date are present.
• Add a reliable contact number and address for questions.
• Mark any attached pages as part of the report and number them.

After signing

• Send the report to the required parties: the insurer, the employer, and the state office if needed.
• Provide the patient a copy upon request, following privacy rules.
• Note the submission date, method, and recipients in the chart.
• Store the signed report and all attachments securely in the medical record.
• Calendar the next clinical review date to reassess restrictions or MMI.
• Set a reminder to send a supplemental report if pending tests will change status.
• Issue a separate work status note to the patient if your clinic uses one.
• Confirm receipt if the report affects imminent decisions, such as return to work or surgery.

Common Mistakes to Avoid

• Leaving work restrictions blank or vague. If you do not specify limits, the patient may be sent back to full duty prematurely. This can aggravate the injury and create disputes. Don’t forget to write clear, functional limits and an effective date.
• Skipping the MMI question. If you do not address MMI when it is appropriate, benefit decisions can stall. This can delay case closure and any impairment assessment. Mark MMI with a date when reached, or explain why it has not been reached yet.
• Omitting objective findings. A report that lists only pain without exam results or test data can be discounted. This can lead to denials for treatment or wage replacement. Include key exam measurements, imaging summaries, and neurological findings.
• Using the wrong claim number or injury date. Misidentification can cause the report to be misfiled or ignored. This delays care authorization and payment. Verify identifiers against the intake sheet before you sign.
• Avoiding a causation opinion. If you stay silent on causation, others will fill the gap without your clinical perspective. This can harm the patient’s claim and undermine your care plan. Provide a good-faith medical opinion, even if provisional.
• Missing signature or date. An unsigned or undated report may be treated as incomplete. That can halt decisions and trigger repeat requests. Sign and date every report and attachment.

What to Do After Filling Out the Form

1. Submit promptly to the required recipients. Use the delivery method your clinic has on file, such as secure electronic submission, fax, or mail. If time-sensitive, choose a method that provides confirmation.
2. Confirm receipt. If your report changes work status, surgery plans, or MMI, follow up to ensure it was received and logged. Note the confirmation in the chart.
3. Communicate with the patient. Explain your work restrictions, the expected recovery timeline, and any next steps. Provide a simple work note that mirrors the restrictions in your report.
4. Coordinate with the employer contact when appropriate. Clarify restrictions and return-to-work options. Encourage a transitional or modified duty plan if medically suitable.
5. Update as the clinical picture changes. Issue a supplemental report after key events: new imaging findings, surgery, major therapy milestones, change in work status, or MMI. Label supplements clearly and reference the original report date.
6. Document and retain. Keep all versions, attachments, and submission confirmations. Maintain a timeline of treatment and reporting events in the chart.
7. Address errors quickly. If you discover an error or omission, send an amended report immediately. Identify the change, explain why, and date the amendment.
8. Support complex decisions. If work capacity remains unclear, consider ordering a functional capacity evaluation. Use the results to refine restrictions. If you assign an impairment rating, back it with detailed measurements and consistent methodology.
9. Plan for closure. Once the patient reaches MMI, complete the final report with the MMI date, stable work status, and any impairment rating. Note recommended maintenance care or future medical considerations when appropriate.
10. Respond to follow-up questions. Be ready to clarify restricted activities, anticipated duration, and the medical basis of your opinions. Provide concise, consistent answers that align with your report.
11. Align billing with documentation. Ensure that billed services match the treatments and evaluations documented in your report. Accurate reports support timely payment and reduce rework.
12. Maintain professional tone and clarity. Your report may be read by non-clinicians. Use plain language, short sentences, and clear headings when you attach narratives. Avoid jargon that can be misinterpreted.
13. Keep patient privacy front of mind. Share only information relevant to the injury and claim. Redact unrelated medical details in attachments unless they affect causation or treatment decisions.
14. Monitor return-to-work outcomes. If the employer cannot accommodate the restrictions, reassess quickly. Update the report if restrictions change or if the patient can advance to increased duties.
15. Prepare for disputes. If another provider disagrees with your findings, keep your data organized. Objective measurements, consistent notes, and clear rationales will support your opinions.
16. Track deadlines internally. Create a checklist in your clinic system to trigger reports at key milestones: initial visit, post-operative checks, therapy completion, and MMI. This reduces last-minute rushes and missing information.
17. Review for consistency. Ensure the mechanism of injury, body part, and diagnosis are consistent across your notes, imaging summaries, and the report. Inconsistencies cause delays and challenge credibility.
18. Clarify apportionment if relevant. If a prior condition contributes to the current impairment, explain the proportion attributable to the work injury, based on medical evidence. Be clear and conservative in your estimation, and identify the data you used.
19. Set patient expectations. Tell the patient when you will revisit work status and MMI. Explain the importance of following restrictions and attending therapy. Document nonadherence and its impact on recovery.
20. Close the loop at the case end. When treatment is complete and the claim is stable, send a final report. Include MMI, permanent restrictions (if any), impairment rating, and future care recommendations. Archive all related documents neatly for easy retrieval.