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Return To Work Doctor Evaluation Form
"I need a Return To Work Doctor Evaluation Form for a manufacturing employee returning from long-term stress leave, with specific focus on phased return and workplace adjustments for a high-pressure environment."
1. Employee Information: Basic details including name, employee ID, department, role, contact information
2. Medical Professional Details: Name, qualifications, registration number and contact details of examining doctor
3. Absence Information: Details of current absence period, including start date, nature of illness/injury, and previous relevant medical history
4. Clinical Assessment: Current health status, examination findings, impact on work capability, and ongoing treatment plans
5. Work Capability Statement: Clear statement of fitness to return to work, including any limitations or restrictions
1. Specialist Referral Information: Details of any specialist consultations or referrals, to be included when complex medical conditions require specialist input
2. Workplace Adjustment Requirements: Specific workplace modifications or adjustments needed for safe return to work, included when adjustments are necessary
3. Phased Return Schedule: Detailed plan for gradual return to work, including hours and duties progression, used when gradual return is recommended
1. Medical Test Results: Relevant test results, imaging reports, or specialist medical reports supporting the evaluation
2. Risk Assessment: Workplace risk assessment specifically related to the employee's medical condition and return to work
3. Consent Forms: Employee's signed consent for medical examination, data sharing, and authorization for return to work evaluation
4. Follow-up Schedule: Detailed timeline for review appointments and progress assessments post-return to work
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