Forms & Resources
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Download the Forms You Need
Before your visit, download and complete the required forms below. This helps us process your care and claims efficiently without delays. Please fill out the forms on your computer, then save and submit them via our contact page.
Medical Evaluation & Claims Assistance
Our experienced providers conduct detailed medical evaluations to assess your injury, determine impairment ratings, and deliver accurate documentation that meets U.S. Department of Labor (DOL) standards. We assist with all federal claims paperwork, including:
Your completed intake paperwork helps our providers get to know you and your medical history. We rely on its accuracy and completeness to provide you with the best care possible.
A brief questionnaire used to assess your risk for opioid misuse and help manage your pain responsibly.
Basic personal and legal information we need to open your case and ensure accurate documentation.
A medical history checklist to help your provider understand your current and past symptoms.
Controlled Substance Agreement
Required for patients receiving pain medication to ensure safe and compliant treatment.
Why Do We Need Health Insurance?
Explains why we ask for your insurance information even though federal claims are filed through OWCP.
Authorizes FedCare to submit claims and receive direct payment on your behalf.
Explains your rights and protections under the Federal Employees' Compensation Act.
FedCare Health Insurance Agreement
Acknowledges your understanding of how your health insurance works with federal claims.
Outlines how we handle your medical information in compliance with HIPAA regulations.
Authorizes us to send or receive medical records to assist with your care and claim.
Official Department of Labor & OWCP Resources
These external links offer additional guidance, forms, and claim information:
U.S. Dept. of Labor Forms:
Need help figuring out which forms apply to your case?
Reach out to us! Our team is here to guide you.
Know Your Rights
You have the right to receive quality medical care. You have the right to go to the doctor of your choice. You have the right to have your medical diagnosis and treatment covered under the Federal Employees’ Compensation Act. You may also have the right to FECA benefits outside the scope of your medical care. You have the right to a frustration-free FECA claims process.
“The Federal Employees’ Compensation Act provides federal employees injured in the performance of duty with workers’ compensation benefits, which include wage-loss benefits for total or partial disability, monetary benefits for permanent loss of use of a schedule member, medical benefits, and vocational rehabilitation. This Act also provides survivor benefits to eligible dependents if the injury causes the employee’s death. FECA is administered by the Office of Workers’ Compensation Programs (OWCP).” – United States Department of Labor
Unfortunately, failure to follow claims rules or submit the required medical evidence at each step in the claims process can result in a lapse in your FECA benefits – or even the complete denial of benefits. Don’t lose your benefits over a complicated process or a minor paperwork oversight.
FedCare has been caring for federal workers injured in the workplace for over 30 years. Our team has extensive knowledge and hands-on experience with FECA cases, and we’re ready to advocate for your rights as a federal employee. We will guide and support you through the entire FECA claims process, assist you in completing and processing all required paperwork, provide a proper medical diagnosis, and develop an individualized treatment plan for you. We will be there to support you every step of the way on your road to recovery.
Let us be your advocate for the benefits and care you deserve.
Federal Agencies
