Paperwork for physical medicine and rehabilitation

A note before you read

I practice internal medicine, so this page is about the forms, not about rehabilitation itself. The findings, the limits and the dates have to come from the clinician treating the patient.

FMLA forms during rehabilitation

The WH-380-E has a place for each part of a recovery, and a long recovery can use several of them. The form asks you to complete every item that applies. The time the patient cannot work at all is a continuous period, with a start date and your best estimate of the end. Therapy after that goes in the item for referrals to other providers, which gives physical therapy as its own example and asks for the start and end dates and how often, such as three days a week. If the patient can go back on shorter days first, the form has a separate item for a reduced schedule, such as five hours a day. Follow-up visits and unpredictable flare-ups have items of their own.

For a patient leaving a hospital or an inpatient rehabilitation unit, the overnight stay and the treatment after it already meet one of the FMLA’s tests for a serious health condition. Therapy on your referral can also count toward the test for more than three full days of incapacity, which has its own rules on how soon and how often the patient is seen. The form’s own instructions say that terms such as “unknown” or “indeterminate” may not be sufficient, so I would give the end dates I expect and say when I will reassess.

A spouse or adult child who will help at home may bring a WH-380-F. On that form your patient is the family member who is ill, not the employee asking for the leave, so I would get a signed authorization from the patient first. FMLA paperwork for doctors covers both forms, with walkthroughs of the WH-380-E and the WH-380-F.

Attending Physician Statements for disability claims

If the patient is claiming short-term or long-term disability benefits, the insurance company has its own Attending Physician Statement. It is a separate question from FMLA leave, even when the two forms arrive together. It asks for the diagnosis, what the patient can and cannot do, and when you expect that to change. This is where specific answers about function help most, such as transfers, hand use, how far the patient walks and with what device, how long they can sit or stand, and what they can lift. Some forms, Unum’s for example, ask separately what the patient should not do and what they cannot do. I would give a return-to-work estimate when I can support one, and when I cannot yet, say why and when I will see the patient again. The Attending Physician Statement guide walks through the questions the carriers ask.

Workers’ compensation, impairment and maximum medical improvement (MMI)

A workers’ compensation status report wants what the worker can do and until when, in terms an employer can act on, and the walkthroughs cover the Texas DWC-073, the Washington Activity Prescription Form and the federal CA-17 and CA-20. Later in a claim the forms change. Some states want MMI and any permanent impairment on a separate report, such as Texas’s DWC069, Tennessee’s C-30A or New York’s C-4.3. Reaching MMI is not the same as being ready for unrestricted work, and Texas’s form says it does not end the worker’s medical benefits. Washington’s form asks whether there is any permanent partial impairment and whether you will rate it, refer the patient or ask for an independent exam, and it names who is qualified to rate, so I would read a form’s instructions on rating before starting. Workers’ compensation reports ask for the diagnosis, and HIPAA allows you to give what workers’ compensation law requires or allows, so I would send what the form asks for and no more.

Disabled parking placards

Every state and D.C. sets its own rules for what the clinician signs. Most of the forms list not being able to walk 200 feet without stopping to rest, and many list not being able to walk without a brace, cane, crutch, another person, a wheelchair or another assistive device. Some go further. California’s form has separate boxes for a disease that substantially impairs mobility and for needing an assistive device to move. It also has boxes for limited use of the legs and for the loss or loss of use of both hands. I would check the conditions that fit, give any description the form asks for, and give the expected duration in the state’s own categories, since it can affect which placard the patient may get. Disabled parking placard applications compares the states.

Return-to-work and accommodation letters

When the patient goes back to work, the employer usually wants a short note, when they can return and with what limits, and until when. A routine one does not need the diagnosis. If the patient needs a change at work, such as a workstation they can reach from a wheelchair or a shorter day, 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 patient and the employer then work out the details between them.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms rehabilitation physicians are asked to complete, such as FMLA forms, insurers’ disability statements, workers’ compensation forms, parking placard certifications and return-to-work 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

How do I put therapy visits on an FMLA form?

On the WH-380-E, therapy you refer the patient to goes in the item for referrals to other providers, with the start and end dates and how often, such as three days a week. Time the patient cannot work at all goes in the continuous period, and shorter days go in the reduced schedule item. Complete every item that applies.

Can a patient qualify for a parking placard because they use a wheelchair or walker?

Many state forms list not being able to walk without a brace, cane, crutch, another person, a wheelchair or another assistive device. Check the wording on the patient’s own state form.

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.