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Work Release Form From Doctor
"I need a Work Release Form From Doctor for an employee returning from extended stress leave, requiring part-time hours for the first month and specific workplace accommodations for mental health support, with a planned return date of March 15, 2025."
1. Patient Information: Basic identifying details including full name, date of birth, address, and NHS number
2. Doctor Information: Name, GMC number, practice details and contact information of the issuing physician
3. Medical Condition Statement: Brief description of relevant medical condition(s) affecting work capacity
4. Work Capacity Declaration: Clear statement about fitness to return to work and date of return
5. Data Protection Statement: Statement regarding handling of medical information and GDPR compliance
1. Work Restrictions: Details of any specific limitations, accommodations or adjustments needed for return to work
2. Treatment Plan Summary: Overview of ongoing treatment requirements that may impact work schedule
3. Follow-up Requirements: Schedule of any necessary follow-up appointments or assessments
1. Patient Consent Form: Standard form for patient's written consent for information disclosure to employer
2. Medical History Summary: Brief relevant medical history appendix if required for context
3. Workplace Adjustments Guide: Detailed recommendations for any required workplace modifications or accommodations
Authors
Patient
Employer
Work Release
Return to Work Date
Medical Condition
Work Restrictions
Workplace Accommodations
Fitness for Work
Medical Leave
Treatment Plan
Follow-up Appointment
Work Capacity
Regular Duties
Modified Duties
Working Hours
Physical Limitations
Medical Assessment
Healthcare Provider
Occupational Health Assessment
Medical Practitioner Authorization
Medical Condition
Fitness Assessment
Work Restrictions
Return to Work Conditions
Confidentiality
Data Protection
Workplace Accommodations
Follow-up Requirements
Medical Certification
Duration of Restrictions
Treatment Compliance
Information Release Authorization
Health and Safety
Review and Reassessment
Consent
Professional Declaration
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