Get Employee Medical Information Form

This guide provides comprehensive instructions on how to fill out the Employee Medical Information Form online. Completing this form accurately ensures that your medical information is provided appropriately to Human Resources for sick leave entitlements and accommodations.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated ‘Employee Name’ field. Ensure that this is clear and matches your official identification.
3. In the ‘EMPLOYEE Authorization Section,’ review the authorization statement regarding the release of medical information. Read carefully before signing to indicate your consent.
4. Proceed to the ‘EMPLOYEE Action Section’ and provide your signature along with the date received. This section confirms your acknowledgment and agreement to the terms stated.
5. Next, fill out the ‘HEALTH CARE PROVIDER Section’ by adding the name of your health care provider, their type of practice, and contact details. This allows HR to verify the information provided.
6. Answer the questions regarding your medical condition by checking ‘Yes’ or ‘No’ where appropriate. Be sure to provide clear and honest responses to reflect your situation.
7. If you have a treatment plan in place, indicate if you are cooperating with it, and provide details about your anticipated return to work and any limitations that may apply.
8. For each physical and psychological limitation, check the appropriate boxes and provide comments as needed, explaining any restrictions or recommendations from your health care provider.
9. Once all sections have been completed, review the document for accuracy and completeness before submitting.
10. Finally, you can save changes, download, print, or share the completed form as necessary.

Complete your Employee Medical Information Form online today to ensure your needs are addressed!