Block 15 requires which dates?

• A. The date of insurance enrollment.
• B. Dates patient is unable to work in current occupation.
• C. The date of the patient's last visit.
• D. The date of the request for authorization.

Answer: (B)

The date information in Block 15 is specifically about the patient’s ability to work. It records the dates when the patient became unable to work in their current occupation (and, if applicable, the date they became able to return). This helps the payer understand disability or workers’ compensation status and links the medical claim to work status.

Dates like the insurance enrollment date, the patient’s last visit, or a request for authorization belong to other parts of the form and are not captured in this block.