Embedded Files
NKY Health's Safety Manual
- Replaces: Supersedes all previous materials on the same topic
- Reviewed: Annually
- Section Revised: Separated from Incident Management and Moved to Google Sites 1/1/2022, 1/1/2022
- Contact: Head of Human Resources
A unique set of numbered yellow forms is kept at each site. Human Resources maintains a master list of numbers and orders more forms from the workers compensation carrier when the supply runs low. Please inform Human Resources if more forms are needed at your site.
This Form IA-1 (Workers Compensation - First Report of Injury) with numbered annotations.
Use the dropdown lists below (organized by section) to access instructions for completing each numbered field.
Use the Workers Compensation workflow in AdobeSign to complete the form.
Instructions for Processing the Medical Rx Card
Instructions for Processing the Medical Rx Card
Follow these steps to process the Medical Prescription Drug Card:
Get the card from the site manager.
Detach the Preferred Medical Prescription Drug Card.
Give the card to the employee to present to the pharmacy and to the medical provider. (When the employee is not physically present, you can read the Member ID number from the Preferred Medical Prescription Drug Card to them for use at the pharmacy.)
Complete the top of the remainder of the form email it as a .PDF to hr@nkyhealth.org.
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