Paperwork for pain medicine

A note before you read

I am an internist, so I often help take care of patients with chronic pain, but I’m not a pain medicine specialist. What I can help with is my knowledge of how to complete the paperwork we both are asked to do. The findings, the limits and the estimates come from you, as the clinician treating the patient.

FMLA forms for chronic pain

Chronic pain most often fits the FMLA through the regulation’s route for chronic conditions. That route covers a condition that needs treatment visits at least twice a year and lasts a long time, even when it comes and goes, and that may keep the patient from working in episodes rather than all the time. The WH-380-E then asks you to separate two things, the planned treatment and the flare-ups.

The rule: 29 C.F.R. § 825.115(c) and (f).

Planned treatment is a procedure or a visit you can put a date on, such as an epidural steroid injection or a radiofrequency ablation. The form asks for the dates, and I would also say how long the patient will be away for each one, such as the day of the procedure and the day after, if that is what the patient needs. Flare-ups are the episodes, and the form needs two estimates over the next six months, how often they are likely to happen and how long each one is likely to last. “About twice a month, one to two days each” answers that part, and “as needed” does not. In my experience a form with only one of the two numbers is often not accepted. I would base both numbers on the patient’s recent pattern. Under that route a flare-up day can count even when the patient does not see you for it, and even when it lasts less than three days.

The details are in FMLA paperwork for doctors, with a field-by-field walkthrough of the WH-380-E.

Attending Physician Statements for disability claims

If the patient is claiming short-term or long-term disability benefits, the insurance company sends its own Attending Physician Statement. It asks for the diagnosis, what the patient can and cannot do, and when you expect that to change. For pain, I would answer in function, such as how long the patient can sit, stand or walk at a time, what they can lift and how often, and whether they could work reduced hours, with the findings behind those limits. Some forms, Unum’s for example, ask separately what the patient should not do and what they cannot do. I would take the first and most recent visit dates from the chart. When I cannot yet estimate a return to work, I would say why and when I will see the patient again, rather than leave a bare “unknown”. The Attending Physician Statement guide walks through the questions the carriers ask.

Workers’ compensation reports

After a work injury, the workers’ compensation carrier wants status reports that say whether the worker can work, with what limits, and until when, and later it may want a report on maximum medical improvement (MMI) and any permanent impairment. Many states publish their own form, such as Texas’s DWC073 and Ohio’s MEDCO-14, and federal employees bring the CA-17 and CA-20. A status report is about capacity, so I would give the limits I can support, such as a lifting limit in pounds and how often, or how long the worker can sit or stand. Workers’ compensation reports do ask for the diagnosis, and HIPAA allows you to give what workers’ compensation law calls for, and no more. The walkthroughs cover the Texas DWC-073, the Ohio MEDCO-14 and the federal CA-17 and CA-20.

Disabled parking placards

Every state and D.C. sets its own rules, and a diagnosis of chronic pain does not qualify a patient by itself. What decides it is whether the patient meets one of the conditions the state lists, such as not being able to walk 200 feet without stopping to rest, needing a cane, brace or other device to walk, or being severely limited in walking by an arthritic, neurological or orthopedic condition, which many forms list. I would check the conditions that fit, give any description the form asks for, and choose the duration in the state’s own categories. Disabled parking placard applications compares the states.

Work restriction and accommodation letters

A routine work restriction letter says what the patient can do and until when, such as changing position every 30 minutes for six weeks, and it does not need the diagnosis. If the patient needs a change at work, for a time or for longer, the employer may ask for documentation for an Americans with Disabilities Act (ADA) accommodation. That letter 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 may last. The employer and the patient then work out the details.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms pain medicine clinicians are asked to complete, such as FMLA forms, insurers’ disability statements, workers’ compensation forms, parking placard certifications and work restriction letters, 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. We cannot reset your passcode, so setup asks you to save a recovery code, and if you forget the passcode that code lets you set a new one. 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

Can a patient get FMLA leave for chronic pain?

Yes, through the regulation’s route for chronic conditions, which covers a long-lasting condition that needs treatment visits at least twice a year and may keep the patient from working in episodes. Your part is the medical facts on the form, and the employer decides whether the leave counts as FMLA leave.

How do I fill in flare-ups on an FMLA form?

Give two estimates over the next six months, how often the flare-ups are likely to happen and how long each one is likely to last, such as about twice a month, one to two days each. Put planned procedures in the separate item for planned treatment.

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.