Paperwork for oncology

The paperwork oncologists receive

I am an internist, so I often help take care of patients with cancer, but I’m not an oncologist. What I can help with is my knowledge of how to complete the paperwork we both are asked to do. You can then apply your specialty knowledge and knowledge of your patient for their own forms. This page covers four kinds of paperwork that patients with cancer may bring you, FMLA certifications, disability claim statements, disabled parking applications and Americans with Disabilities Act (ADA) accommodation letters. While I am not an oncologist, I tried to answer questions on them that I would suspect come up for an oncologist trying to complete the forms.

FMLA for treatment, recovery and flare-ups

These patients may need separate absences, a reduced schedule or one continuous stretch away, and the pattern should fit the patient’s limits and treatment plan. The Department of Labor’s WH-380-E, and insurers’ versions such as MetLife’s and The Standard’s, ask about planned treatment and unpredictable episodes in separate places. Planned treatment includes the recovery you expect after each treatment, such as an infusion every 21 days for six cycles with two to three days of recovery after each. Unpredictable episodes are a separate item, and the form needs two estimates, how often and how long each time. The WH-380-E and WH-380-F ask about the next six months, and a carrier’s form may use its own period and units. “About twice a month, one to two days each” is a complete answer to that item, and “as needed” is not. In my experience a form with only one of the two numbers is often not accepted. The same recovery days should not be counted twice.

If a spouse or adult child needs FMLA leave to provide care your patient medically needs, their employer may ask for a certification, which may be the WH-380-F. Your patient is the person who is ill, not the employee, and you describe the care and the time that employee needs away. HR still checks whether the employee is eligible. Before the employee takes the form away, I get a signed authorization from my patient or whoever properly speaks for them. The diagnosis is optional on both Department of Labor forms. FMLA paperwork for doctors has the details.

Chemotherapy on the FMLA form

For chemotherapy, the first question is whether the patient can work between treatments at all. If not, a continuous period of leave may fit better than separate absences. If so, the treatment schedule with its expected recovery goes in the planned treatment item, and only the unpredictable bad days, such as an admission for fever during chemotherapy, go in the episodes item. If the schedule might change, I would give the current plan with an expected end date, such as the last cycle or the next scan, and say what is still uncertain. A significant change can lead the employer to ask for a new certification, within the FMLA’s timing rules.

Attending Physician Statements for disability claims

Short-term and long-term disability insurers each send their own Attending Physician Statement. These ask for the diagnosis too, but what the insurer needs most is function, meaning what the patient can and cannot do, for how long, what findings support that, and what you expect to change. “Unable to work” on its own is weak. “Can sit for 30 minutes at a time, short of breath walking one block on level ground” gives the insurer something to decide on, with the numbers coming from your own assessment. Some forms also separate what the patient cannot do from what you advise against, and ask about cognitive limits as well as physical ones. The Attending Physician Statement guide goes through the questions.

Disabled parking

Every state and D.C. sets its own rules for what you sign, usually a section of its own application. Most of them list the same short set of qualifying conditions, which go back to a federal model. The conditions are alternatives, so a patient who misses one may meet another. The list printed on that state’s form is the one that counts, along with any description or test result it asks for. Cancer itself is not on most lists, so for an oncology patient I would look at the walking and oxygen criteria. Disabled parking placard applications compares the states.

ADA accommodation letters

When a patient can work but needs a change to do it, the employer may ask for documentation, though not when the disability and the need are obvious or already documented. When a letter is needed, it describes the activities the condition limits, how that affects the patient at work, the changes that would help and why, and how long the limits are expected to last, such as a flexible schedule around treatment or more frequent breaks. I would state the medical limits clearly and word the changes as suggestions. The employer may choose another change that works, and the employer and the patient work that out together.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms oncologists are asked to complete, such as FMLA forms, insurers’ disability statements, state disability forms and parking placard certifications, so you can fill them out more quickly and more confidently. You set up your information once on each computer you use. Then you answer one question at a time, and nothing goes on the form until you confirm it. Before you sign, it flags some problems, such as family history or a gene test result on an FMLA form. Then you review the completed form, and if everything looks correct, you sign it and you’re done.

Your patients’ information is encrypted on your own device with a passcode only you know, and none of it is sent to us or anyone else. Because we never receive it, there is no business associate agreement to sign with us. HIPAA still applies to how your office handles that computer, any copies you export, and the forms you print and sign. If you want to see whether it helps with your own paperwork, try the free trial, and I think you will find it saves you time and makes the forms more intuitive to complete.

Questions the office asks

How do I fill out FMLA paperwork for chemotherapy?

Put the treatment schedule and the recovery you expect after each treatment in the planned treatment item. If there are also unpredictable bad days, give two estimates in the episodes item, how often they are likely to happen and how long each is likely to last. If the patient cannot work between treatments at all, a continuous period of leave may fit better. The diagnosis is optional on the Department of Labor forms.

Can a family member get FMLA leave to care for my patient?

Yes, if your patient medically needs their care. The employer may ask for a certification, which may be the WH-380-F. Your patient is the person who is ill, not the employee, and you describe the care and the time that employee needs away. I get a signed authorization from my patient before the employee takes the form away.

Can my nurse or medical assistant fill in the form for me?

Yes. A provider can add staff such as a nurse or medical assistant, at no extra charge, and each one gets their own passcode. They can fill in the whole form and mark it ready for you, but only the certifying provider can sign it, so I would read what they entered before signing. Everything stays on one computer, so a simple setup is one laptop or tablet kept just for forms that staff and clinicians share. How staff help with forms is the practice’s to arrange and supervise.