ࡱ> 130` +bjbjss *+ D2         $vh          "   ;   P;? $ "S  0D[ ,jF jj j           D       PHYSICIAN RETURN TO WORK LETTER Re: (Employees Name) Date: Dear Dr: (Company name) Return to Work Program provides assistance to our injured employees in accomplishing as expeditious and productive a return to work as possible. Everyone benefits when an injured employee returns to work. The employees self esteem, earning potential and co-worker relationships are maintained, and we retain a valuable employee. You play an important role in this effort. We need your help in defining (Employees Name) current physical capabilities so that we may return (him or her) to regular duty or identify an appropriate transitional duty that will be both rewarding and therapeutic for (him or her). I am enclosing an employee job description so that you will have a better picture of the employees regular job duties. Please fax the following information regarding (Employees Name) current physical status to us at (Fax number). List and describe any physical restrictions/limitations based on the enclosed job description List and describe activities the employee can and should be performing to heighten recovery Describe the current work status: ie. Still Improving, etc. Describe any visual or hearing limitations that may affect performance Describe any medications the employee is taking that may affect performance Describe any pre-existing conditions that may have contributed to or exacerbated the injury Based upon (Employees Name) job description, at this time do you release (him or her) to: _____ Full Duty _____ Transitional Duty as outlined _____ No work activities If the employee is currently restricted from all work activities, when do you project (he or she) will be capable of engaging in any work activities? If necessary, (Company name) will consider accommodations to help the employee perform essential job functions. If transitional duty is appropriate, I will be contacting you for your input and approval. Should you have any questions, please contact me at (Phone number). Thank you for you help. Sincerely, Name Form AB-W-3  +hfmHsH hfCJhf !"89?@IJ 7 8  c 2 ^ & F$a$+'(CD+^(/ =!"#$% D@D NormalCJOJQJ_HmH sH tH DAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List 0>@0 Title$a$CJ+ !"89?@IJ78c2'(CD-000000000000000 0 0 0 0 0 000000000000000000000000000+ + + *-*-39?@IJ8*C-- = (S^`OJPJQJ^Jo(   ^ `OJQJo(o   ^ `OJQJo( xx^x`OJQJo( HH^H`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o ^`OJQJo( =}        f3cJ-@H+?+P@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"qh8888!24''2QHX)?f2PHYSICIAN RETURN TO WORK LETTERKelly CatanzaroCMD Oh+'0 ( H T `lt| PHYSICIAN RETURN TO WORK LETTERKelly Catanzaro Normal.dotCMD2Microsoft Office Word@F#@0?@0?8՜.+,0 hp  Arcara & Borczynski'  PHYSICIAN RETURN TO WORK LETTER Title !"#$%&')*+,-./2Root Entry FP?4Data 1TablezWordDocument*SummaryInformation( DocumentSummaryInformation8(CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q