Paperwork for psychiatry and psychology

FMLA for depression, anxiety and other mental health conditions

I am an internist, so this page sticks to what the forms ask and what the rules allow, not how to treat, and I name the rule under each section so you can check my reading. A mental health condition can be a serious health condition under the FMLA in the same ways as any other. The three that come up most clearly are an overnight inpatient stay, a chronic condition that continues over time, needs treatment visits at least twice a year, and causes periods when the patient cannot work, and a first episode with more than three full days unable to work plus treatment. The certification covers the medical facts. Human Resources (HR) decides whether the employer is covered and the employee is eligible.

The form for the patient’s own condition is the Department of Labor’s WH-380-E, or the employer’s or an insurer’s version such as MetLife’s or The Standard’s. When the employee needs leave to care for a spouse, parent or child with a serious health condition, it is the WH-380-F, and for a child 18 or older the child must also be unable to care for themselves because of a disability. Psychologists and clinical social workers can complete these forms, not only physicians. The FMLA regulations count clinical psychologists, clinical social workers, nurse practitioners and physician assistants, among others, as long as they are working within their scope of practice under state law.

The form asks about planned treatment and unpredictable episodes in separate places. For planned treatment, give the dates or frequency and how much time the patient needs away each time, including any recovery, such as a one-hour therapy visit each week, or an intensive outpatient program three mornings a week for six weeks. For 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” supplies both parts if that fits the expected course, and “as needed” does not. In my experience a form with only one of the two numbers is often not accepted. It is an estimate, and if absences run well past it, the employer may ask for a new certification. On the WH-380-F, the numbers are the time the employee needs away to give care, which may differ from how long the patient’s episodes last.

The diagnosis is optional on the Department of Labor forms, and some state or local laws may not allow it. On the form for the employee’s own condition you can describe the symptoms and how they keep the patient from working, such as being unable to concentrate long enough to finish a shift, without naming the condition, though a state’s rules may limit symptom details too. Separately kept psychotherapy notes never go with the form. HIPAA treats them apart from the rest of the record, and releasing them generally needs their own separate authorization. Before the ordinary form goes to HR, or the leave administrator the employer uses, I would check the release too, and for a family-care form that means permission from the patient or someone who can act for them, not just the employee taking leave. My understanding is that the employer may contact you only to confirm or clarify the form, through HR or a leave administrator, and never through the patient’s direct supervisor. FMLA paperwork for doctors has the details.

The rule: 29 C.F.R. §§ 825.114, 825.115(a) and (c), 825.122, 825.125, 825.306, 825.307(a), 825.308; 45 C.F.R. § 164.508(a)(2) for psychotherapy notes.

Short-term and long-term disability claims

If the patient is applying for short-term or long-term disability benefits, the insurer sends its own Attending Physician Statement, which is separate from the FMLA form even when both cover the same absence. It will ask for the diagnosis, which the FMLA form did not need, and some carriers also ask for chart notes, which are not the same thing as separately kept psychotherapy notes. What it really turns on is function. I would connect the patient’s limits to the work the form asks about, such as how impaired concentration affects completing specific job functions, keep what the patient reports separate from what you observed, such as mental status findings and rating scores with their dates, and give the dates and expected course it asks for. “Too depressed to work” gives the insurer little to go on. Some forms have questions of their own. New York Life’s GB-608066, for example, still has an Axis I to V and Global Assessment of Functioning (GAF) section, and its GAF prompt lets you leave the score blank if you do not use it.

Some long-term disability policies limit benefits for mental health conditions. I would still answer the form’s questions about the diagnosis, other conditions, treatment and hospital stays accurately, and leave the policy’s limits to the patient and the insurer. The Standard’s SI 3379 also asks whether the patient can manage benefit payments, and I would answer that from what I have seen. The Attending Physician Statement guide goes through the questions.

Americans with Disabilities Act (ADA) accommodation letters

Many patients can keep working with a change at work, and the employer may ask for documentation, though not when the disability and the need are obvious or already documented. The letter describes which major life activities the condition substantially limits, such as concentrating, sleeping or interacting with others, judged as the condition is when it is active and without the benefit of treatment. It then describes the patient’s present difficulty at work, changes that would help, such as a flexible schedule for appointments, a quieter workspace, written instructions or working from home some days, and how long they may be needed. A patient doing better on treatment may still need an accommodation. The employer and the patient work out the details together, so I would make the suggestions clear but not word them as orders. The diagnosis may not be needed, and what is disclosed is the patient’s decision, but the letter still has to support the disability and the change.

The rule: 29 C.F.R. § 1630.2(j).

Housing accommodation letters

Under the Fair Housing Act, a person with a disability can ask a landlord or housing provider for a reasonable change to a rule or a policy, or for a reasonable physical modification to the home, when that is needed to use and enjoy the dwelling. Under that law the resident generally pays for a physical modification, though other laws may change that. A letter from you supports the request, but it does not decide whether the request has to be granted. The diagnosis is not required.

Before signing one, I would check that I can support what it says. The PatientPapers letter states that the patient has a condition that substantially limits one or more major life activities, and that in your clinical judgment the change is necessary to give them an equal opportunity to use and enjoy the home. Wanting a quieter apartment is not enough by itself, so the letter should explain how the limitation connects to the change, such as a transfer to a quieter unit or a ground-floor apartment.

The rule: 42 U.S.C. § 3604(f)(3).

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms mental health clinicians are asked to complete, such as FMLA forms, insurers’ disability statements, state disability forms and accommodation and housing letters, so you can fill them out more quickly and more confidently. Psychologist and clinical social worker are on its list of credentials, though each form sets who may sign it. 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 a diagnosis on a form that does not need one. 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

Can a psychologist fill out FMLA paperwork?

Yes. The FMLA regulations count clinical psychologists and clinical social workers as health care providers, as long as they are working within their scope of practice under state law.

Do I have to put the psychiatric diagnosis on FMLA paperwork?

No. The diagnosis is optional on the Department of Labor forms, and some state or local laws may not allow it. On the form for the employee’s own condition you can describe the symptoms and how they keep the patient from working without naming the condition, though a state’s rules may limit symptom details too.

What does a short-term disability form for depression need from me?

The diagnosis, the treatment, and above all function, connected to the work the form asks about, such as how long the patient can concentrate, whether they can keep a regular schedule, and how they handle other people and stress at work. Keep what the patient reports separate from what you observed.

Can the PatientPapers housing letter be used as an emotional support animal (ESA) letter?

No. The PatientPapers housing accommodation letter does not cover emotional support animals or any other assistance animal.

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.