WORK COMP

New Patient Work Comp Intake Form

Workers' Compensation Department

Our Work Comp Department team is committed to assisting patients who have been injured during the course of their employment in a fair and timely manner. Our commitment aims to provide the patient with the best possible outcomes using the most appropriate treatment path, whether surgical or non-surgical.

Rockhill Orthopaedics has a team dedicated to coordinating the required authorizations and paperwork, as well as serving as a liaison between the injured worker, occupational medicine clinics, case managers, employers, insurance companies and medical providers.

Our Workers’ Compensation Team:
Linda Pettigrew
Workers’ Comp Secretary
816-251-7203

Cheryl McIntosh
Workers’ Comp Specialist
816-251-7244

Mary Garcia
Workers’ Comp Specialist
816-251-7213

Contact us for referrals and assistance:
Phone: 816-251-7203
Fax: 816-246-8811

Information Necessary for a Work Comp Referral:
  • Injured Worker Name / Address / Date of Birth
  • Date of Injury
  • Job Title / Job Description (written job description to be provided to the physician at initial appointment)
  • Employer Name / Address / Phone Number
  • Employer Contact Person
  • Claim Number
  • Treatment to date, if applicable
  • Claims Adjuster Name / Company / Address / Phone Number / Fax Number
Fill out form at left or download PDF below.

Workers’ Compensation Services Offered:
Evaluation and treatment of orthopedic injuries
Orthopedic surgery (from arthroscopy to joint replacement)
Physical Medicine and Rehabilitation (PM&R)
Physiatry
Therapeutic injections
Spinal injections (under fluoroscopy)
Electromyography (EMG)

At the end of each office examination, the injured worker will receive a work status report with information about their condition and treatment progress. Our dedicated team will also fax this report to the case manager or insurance provider within 24 to 48 hours of each visit.

Legal Services Offered:
Independent medical examinations (IME)
Second opinions and ratings
Expert opinions and testimony
Missouri Workers’ Compensation Resources:
Here is a link for the Missouri Department of Labor Workers’ Compensation website: https://labor.mo.gov/dwc
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