Paperwork for pulmonology

The paperwork pulmonologists receive

I am an internist, so I often help take care of patients with COPD and other lung conditions, but I’m not a pulmonologist. What I can help with is my knowledge of how to complete the paperwork we both are asked to do. You can then apply your specialty knowledge and knowledge of your patient for their own forms. This page covers four kinds of paperwork that patients with COPD or other lung conditions may bring you, FMLA certifications, disability claim statements, disabled parking applications and Americans with Disabilities Act (ADA) accommodation letters. While I am not a pulmonologist, I tried to answer questions on them that I would suspect come up for a pulmonologist trying to complete the forms.

FMLA for treatment, recovery and flare-ups

These patients may need separate absences, a reduced schedule or one continuous stretch away, and the pattern should fit the patient’s limits and treatment plan. The Department of Labor’s WH-380-E, and insurers’ versions such as MetLife’s and The Standard’s, ask about planned treatment and unpredictable episodes in separate places. Planned treatment includes the recovery you expect after each treatment, such as pulmonary rehab twice a week for eight weeks. Unpredictable episodes are a separate item, and the form needs two estimates, how often and how long each time. The WH-380-E and WH-380-F ask about the next six months, and a carrier’s form may use its own period and units. “About twice a month, one to two days each” is a complete answer to that item, and “as needed” is not. In my experience a form with only one of the two numbers is often not accepted. The same recovery days should not be counted twice.

If a spouse or adult child needs FMLA leave to provide care your patient medically needs, their employer may ask for a certification, which may be the WH-380-F. Your patient is the person who is ill, not the employee, and you describe the care and the time that employee needs away. HR still checks whether the employee is eligible. Before the employee takes the form away, I get a signed authorization from my patient or whoever properly speaks for them. The diagnosis is optional on both Department of Labor forms. FMLA paperwork for doctors has the details.

The lung criteria on parking forms

Many state parking forms include lung disease with an FEV1 under one liter (in liters, not percent of predicted), or an arterial oxygen tension under 60 mmHg at rest on room air, and most include using portable oxygen. A result taken from the chart should have been measured under the conditions the form prints, and attach the report if the form asks for one. Some states, Massachusetts for example, also want the diagnosis and a description. A patient who does not qualify based on their FEV1 or supplemental oxygen requirement may still meet a walking criterion.

Attending Physician Statements for disability claims

Short-term and long-term disability insurers each send their own Attending Physician Statement. These ask for the diagnosis too, but what the insurer needs most is function, meaning what the patient can and cannot do, for how long, what findings support that, and what you expect to change. “Unable to work” on its own is weak. “Short of breath after walking one block on level ground or climbing one flight of stairs, and can’t carry more than 10 pounds” gives the insurer something to decide on, with the numbers coming from your own assessment. Some forms also separate what the patient cannot do from what you advise against, and ask about cognitive limits as well as physical ones. The Attending Physician Statement guide goes through the questions.

Disabled parking, and the lung criteria

Every state and D.C. sets its own rules for what you sign, usually a section of its own application. Most of them list the same short set of qualifying conditions, which go back to a federal model. The conditions are alternatives, so a patient who misses one may meet another. The list printed on that state’s form is the one that counts, along with any description or test result it asks for. Several of those conditions are written for lung disease, described above. Disabled parking placard applications compares the states.

ADA accommodation letters

When a patient can work but needs a change to do it, the employer may ask for documentation, though not when the disability and the need are obvious or already documented. When a letter is needed, it 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 are expected to last, such as more frequent breaks or a workplace away from fumes and dust. I would state the medical limits clearly and word the changes as suggestions. The employer may choose another change that works, and the employer and the patient work that out together.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms pulmonologists are asked to complete, such as FMLA forms, insurers’ disability statements, state disability 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

Does COPD qualify for a disabled parking placard?

Many state forms include lung disease with a forced expiratory volume in one second (FEV1) under one liter or an arterial oxygen tension under 60 mmHg at rest on room air, and most include using portable oxygen. A patient who does not qualify based on those may still meet a walking criterion. Each state’s form has its own list.

Does the FEV1 on the parking form mean percent of predicted?

No. The forms that use it ask for a forced expiratory volume in one second (FEV1) under one liter, in liters. A result taken from the chart should have been measured under the conditions the form prints.

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.