Paperwork for primary care

FMLA paperwork (WH-380-E and WH-380-F)

The Department of Labor’s WH-380-E, titled Certification of Health Care Provider for Employee’s Serious Health Condition, is for the employee’s own condition, and the WH-380-F is for an employee who needs time off to care for a spouse, parent or child. On the WH-380-F your patient is the family member who is ill, not the employee, so you may never meet the person asking for the leave. Before the employee takes that form away, I get a signed authorization from my patient or whoever properly speaks for them, because the employee’s request for leave is not my patient’s permission. Nurse practitioners and physician assistants count as health care providers under the FMLA regulations too, within their scope of practice under state law. Quite often the form is an insurer’s own version instead, such as MetLife’s or The Standard’s, and in my experience it is the same questions in a different order.

Before you start, it helps to know that the diagnosis is optional on the WH-380-E and WH-380-F, and that genetic information stays off them, which means genetic tests and illness in the family. Optional does not mean blank, though, because the form still needs enough medical facts to show why the leave is needed, such as the visits, the treatment and the symptoms that keep the patient from working. I leave family history off, and on the WH-380-F you still describe your own patient’s condition. Then, for unpredictable episodes, 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. Planned treatment is a separate item, and it wants the dates or the schedule and the time away each visit. If the employer finds the form incomplete, my understanding is that it has to say in writing what is missing and allow seven days to fix it. The employee generally has 15 calendar days to return the form in the first place, so I would note the date it came in.

The details are in FMLA paperwork for doctors, with field-by-field 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 sends its own Attending Physician Statement. Despite the name, I would read its signature section to see who may sign it. It supports the benefit claim, which is separate from FMLA leave even when the two forms arrive together, so I would make the dates on the two agree. It can ask for more, and I do put the diagnosis on those, along with what the patient can and cannot do, whether they could work reduced hours, and when I expect that to change. Some forms, Unum’s for example, ask separately what the patient should not do and what they cannot do, and I would take the first and most recent visit dates from the chart. I would give a return-to-work estimate when I can support one. When I cannot yet, I would say why and when I will see the patient again, rather than leave a bare “unknown”, and some carriers’ forms have a place for exactly that answer.

The Attending Physician Statement guide walks through the questions the carriers ask.

Disabled parking placards

Every state and D.C. sets its own rules for what the clinician signs, and for who may sign it. New York’s form names nurse practitioners and physician assistants, and some states name fewer, so I would read the signature section first. In most states it is a section of the state’s application, but a few take something else, such as a statement on your letterhead in Iowa and New Jersey or a prescription in Ohio. Most of the forms list the same few qualifying conditions, such as not being able to walk 200 feet without stopping to rest, using portable oxygen, or a heart condition at functional Class III or IV. A few states use 100 feet instead, so I would go by the list printed on that state’s form. Check the conditions that apply, fill in any description the form asks for, as California’s does for several of its boxes, and give the expected duration in the state’s own categories, because that decides which placard the patient gets.

Disabled parking placard applications compares the states, with a page for each of twelve of them.

Jury duty excuses

Most of the jury duty requests I get don’t include the summons the patient received. They are a portal message from the patient asking me to write a letter so they can be excused. I practice in Missouri, and it may work differently elsewhere. If I am inclined to write one, it is reasonable to ask the patient for a copy of the summons and whatever papers came with it, so I can see what the court asks for. A few courts publish their own medical excuse sheet. Arizona, Connecticut and New Jersey are three of them, and if the summons came with one, that is the form to use. Otherwise I would read the summons and the court’s instructions first, because courts ask for different things. Some want the symptoms and how long they will last, and some ask you to leave private health information out. In general the clerk needs why the patient cannot serve, in terms of what they can and cannot do, and whether that is for a while or for good. The court decides whether to excuse or postpone. Sometimes the juror is not your patient at all but your patient’s caregiver. Then I would describe the care your patient needs during the hours of jury service, and say no one else can provide it only if I know that to be true.

Return-to-work notes, school notes and Americans with Disabilities Act (ADA) letters

A routine return-to-work or work restriction note should say what the patient can do, such as no lifting over 20 pounds for two weeks, and when that ends. It does not need the diagnosis. A fitness-for-duty request after FMLA leave is different, and if the employer sent a list of the job’s essential functions, it may ask whether the patient can do those. A school or daycare note should say something the school can act on, such as the days the child was unable to attend, the day they can come back, or what to skip in gym class and until when. When an employer asks for documentation for an ADA accommodation, the 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 together.

Where PatientPapers fits

I am an internist in primary care, so this is the paperwork I understand best, and I built PatientPapers for it. PatientPapers walks you through the forms that come up in primary care, such as FMLA forms, insurers’ disability statements, parking placard certifications and the letters above, 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 or a diagnosis the form does not require. 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

What should a jury duty excuse letter from a doctor say?

Why the patient cannot serve, in terms of what they can and cannot do, and whether that is for a while or for good, along with anything else the court’s instructions ask for. If the court sent its own medical excuse sheet, as Arizona, Connecticut and New Jersey do, use that instead.

Do I have to put the diagnosis on FMLA paperwork?

No. The diagnosis is optional on the WH-380-E and WH-380-F, and some state or local laws may not allow it. An insurer’s disability claim statement is different and usually asks for it.

Does a return-to-work note need the diagnosis?

Not a routine one. A return-to-work or work restriction note should say what the patient can and cannot do, and until when. A fitness-for-duty request may ask whether the patient can do the job’s essential functions, but that still does not require the diagnosis.

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.