Paperwork for orthopedics

A note before you read

I practice internal medicine, but we all fill out some of the same paperwork, so this page is about the forms and what I think would be helpful for orthopedic surgeons to know. The findings, the restrictions and their dates have to come from the clinician treating the patient, who knows the specifics. Return-to-sport clearance is outside what this page covers.

Workers’ compensation reports

After a work injury, the workers’ compensation form you will probably see most is the work status report, which tells the employer and the insurance carrier whether the patient can work, with what limits, and until when. Many states publish their own. Texas has the DWC-073 work status report, Florida the DWC-25, Ohio the MEDCO-14, and Washington the Activity Prescription Form. California has the Doctor’s First Report (Form 5021), the PR-2 progress report and the PR-4 permanent and stationary report. Federal employees bring the Department of Labor’s CA-17 duty status report and CA-20 attending physician’s report. On the CA-17 the employing agency fills in the job’s demands first, so I would ask for that side if it comes blank. If you supervise nurse practitioners or physician assistants, you may need to co-sign some workers’ compensation forms they complete, such as the federal CA-20, and Ohio’s MEDCO-14 after the first six weeks. PatientPapers leaves that co-signature line for you to sign by hand.

So I would first check what kind of report it is. A status report asks about capacity and restrictions, and there “light duty” on its own does not tell an employer anything they can act on. “No lifting over 15 pounds with the right arm, and only occasionally, no work above shoulder height on the right, through December 4” is the kind of answer they can use, with the numbers coming from your own assessment of the patient and the job. Other reports ask more. The CA-20 asks whether the work caused or aggravated the condition and why, and California’s PR-4 asks about permanent impairment, how the rating was reached and apportionment. A short list of restrictions does not answer those. Workers’ compensation reports do ask for the diagnosis, and HIPAA allows you to give the carrier what workers’ compensation law requires.

For the dates, I would keep the expected end of a restriction separate from the date I plan to see the patient again. If the end is not known yet, I would say so and give the next visit, and if the restriction is permanent, I would use the form’s permanent option rather than invent an end date. Some states want a permanent restriction with a date of maximum medical improvement (MMI) on a separate report, such as Texas’s DWC069, Tennessee’s C-30A or New York’s C-4.3.

The walkthroughs go box by box through the Texas DWC-073, the Florida DWC-25, the Ohio MEDCO-14, the Washington Activity Prescription Form and the federal CA-17 and CA-20.

Light duty

Only the employer knows whether it has light-duty work. Your part is to describe what the patient can do, and to say whether a particular job is within those limits when the employer sends its duties. Georgia’s WC-240a, for example, asks exactly that about a described job, and my understanding is that if you approve the job and the worker turns it down, Georgia may suspend weekly benefits, so I would read the job description closely. An employer saying it has no light duty may also not be the end of the matter, because it may have accommodation duties too, but that is between the patient and the employer.

Return-to-work and work restriction letters

Outside workers’ compensation, an employer may want a short note. A return-to-work note says when the patient can go back, and whether that is full duty or with limits. A work restriction letter says what the limits are and how long they last. A routine one does not need the diagnosis. I would first check what is actually being asked for, though, because a status note, an FMLA certification, an Americans with Disabilities Act (ADA) accommodation request and an insurer’s statement can each need different information.

A fitness-for-duty certification after FMLA leave has its own rules. My reading of the regulation is that, for leave for the employee’s own condition, an employer with a uniformly applied policy may require one. To require it to address the job’s essential functions, the employer has to provide the list of those functions by the time of the designation notice, and say in that notice that the certification must address them. So it helps to see that notice and the list.

The rule: 29 C.F.R. § 825.312.

Disability claims and FMLA

If the patient is applying for short-term or long-term disability benefits, the insurer or plan sends its own Attending Physician Statement. It asks for the diagnosis, the surgery date if there was one, what the patient can and cannot do, and when you expect that to change. I would give a return-to-work estimate when I can support one. When I cannot, I would use the form’s own option for that and give the explanation or follow-up it asks for. The Standard’s SI 2047, for example, has an “unable to determine” answer and asks when follow-up is planned. The Attending Physician Statement guide walks through the questions.

The same operation may also bring an FMLA form, the WH-380-E for the patient’s own leave, or a WH-380-F for a family member who will help with the recovery. The disability statement, the leave certification and the return-to-work note answer different questions. For an operation, I would give the continuous period from the surgery to the expected return, then the follow-up and therapy visits after that as planned treatment, and if the injury happened at work I would keep the restrictions on the workers’ compensation report and the FMLA form the same. FMLA paperwork for doctors covers the leave forms.

Disabled parking placards after surgery

Every state and D.C. sets its own rules for what you sign. Usually it is a section of the state’s application, though a few take a statement on your letterhead or a prescription. I would first check whether the patient’s walking limitation meets that state’s criteria, because a recent operation does not by itself. Most state forms list the same few conditions, such as not being able to walk 200 feet without stopping to rest, or not being able to walk without a brace, cane, crutch, another person, a wheelchair or another assistive device. If the patient qualifies and you expect the limitation to resolve, a temporary placard may fit, with an end date you can support and within the state’s limit. California, for example, caps a temporary placard at 180 days. Disabled parking placard applications compares the states.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms orthopedic surgeons are asked to complete, such as workers’ compensation forms, return-to-work and work restriction letters, insurers’ disability statements, FMLA 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 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

What should a light duty note from a doctor say?

What the patient can and cannot do, in terms an employer can act on, such as a lifting limit in pounds and which arm, no overhead work, or sitting and standing as needed, and how long the limits last or when you will reassess. A routine note does not need the diagnosis.

Is light duty my decision?

No. Only the employer knows whether it has a light-duty job. Your part is to describe what the patient can and can’t do, and if the employer sends a job description, to say whether that job fits those limits.

Which workers’ compensation forms does PatientPapers fill?

The federal CA-17 and CA-20, and workers’ compensation forms from 26 states and D.C., such as the Texas DWC-073, the Florida DWC-25 and the Ohio MEDCO-14. The full list is on the PatientPapers coverage page.

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.