Get Generic Treatment Memorandum And Functional Abilities - Employee Niagararegion

Filling out the Generic Treatment Memorandum and Functional Abilities form ensures that employees can effectively communicate their health and functional status. This guide provides a step-by-step approach to complete the form online, ensuring clarity and accuracy in the submission process.

Follow the steps to fill out the form correctly:

1. Click the ‘Get Form’ button to access the document and open it in your editing platform.
2. Complete the employee section. Fill in all required fields, including your name, employee number, phone number, job title, work location, and supervisor name.
3. Provide information for the health care professional's section. This includes the date of assessment and illness/injury commencement dates, selecting if the condition is work-related or not, and describing the nature of the current illness/injury.
4. Indicate the patient's return to work status. Check the applicable box that corresponds to the abilities or restrictions and provide the required details for each activity listed, such as walking, standing, sitting, lifting, and any cognitive restrictions.
5. Complete the physician and patient follow-up section. Mark whether this is a recurrence of a previous condition and if referrals to other health care professionals have been made.
6. In the release of information section, authorize the designated health professional to share information. This includes signing and dating the release and providing necessary contact details.
7. Review all entries for accuracy before finalizing the form.
8. Once all sections are completed, save your changes, and choose whether to download, print, or share the document with the designated contacts as necessary.

Complete your Generic Treatment Memorandum and Functional Abilities form online today for efficient processing!