Get Physician's Return To Work Authorization Form - City Of Klamath Falls

Completing the Physician's Return To Work Authorization Form is an essential step for employees returning to work after medical leave. This guide provides clear instructions on how to fill out this form online, ensuring you meet all necessary requirements efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the Physician's Return To Work Authorization Form and open it in your preferred online editor.
2. Begin by filling out the employee's name and job title in the specified fields. Ensure that the information is accurate as it will be critical for processing the return to work.
3. Indicate the date of the physical examination, making sure to enter the information clearly.
4. In the section regarding the sources of information, check all relevant boxes that apply to your understanding of the employee's essential job functions.
5. Indicate the status of the employee's release for duty by selecting one of the options: full unrestricted duty, modified duty, or not released for any type of duty.
6. If the employee is released to modified work duty, fill out the additional fields, including the estimated date of return to full duty and the date for the next evaluation.
7. Complete the physical limitations section by marking the appropriate columns for each physical activity to specify restrictions accurately.
8. After filling out all required information, sign the form as the treating physician or practitioner and include your printed name, phone number, address, city, state, and zip code.

Complete your Physician's Return To Work Authorization Form online today to ensure a smooth transition back to work.