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Step 6

Develop a Provider Form

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A Provider form needs to be developed so that injured/ill workers can inform the treating provider of your company’s Return-to-Work program and so the company can gather relevant information to find a suitable temporary job assignment for the employee.

Crucial in your consideration of provider forms is to first identify the information necessary to your needs.  Once you know exactly what that information is, selection of the proper form, style, and content should follow.

Additionally, remember to consult medical community representatives that may be present on your Return-to-Work Committee or provider panel for their advice and counsel.  The first-hand knowledge and experiences that these inpiduals bring to the table will truly ease the provider form creation process.


Appendix T: Letter to Health Care Provider About Return-to-Work (PDF)

Appendix U: Return-to-Work Program Temporary Assignment Job Description (PDF)