Loss of Wage Earning Capacity - Consultations with Physicians

May 15

Consultations with physicians to discuss the patient's functional ability can provide specific information to assist the rehabilitation counselor in determining potential vocational outcomes. We have developed a form to assist in estimating a person's workability and job accommodation needs. The following is an example of a physician consultation questionnaire used to gather such information. Feel free to use this tool when you are gathering information about a client.

Below is a summary of the questions included in the form. Click HERE for the form.

PHYSICIAN'S CONSULTATION FORM

Patient/Examinee Name:

1. What is the date of injury?
2. What was the date of the last examination
3. What is the diagnosis?
4. Have diagnostic tests been performed?

If so, please identify the tests, the date, and the findings?

5. What is the prognosis?
6. What is the current medical status?
7. Has the patient reached maximum medical improvement? Date?
8. If no, what is the expected date of maximum medical improvement?

9. Is the patient taking medication that impacts his/her ability to work?

Please explain any limitations:

10. Can the patient be released to his/her previous job or regular work?

11. Can the patient return to temporary light work duty? (Explain limitations or restrictions)

12. Can the patient work based on The Department of Labor Definitions of Physical Demands? Select the maximum strength demand.

___Sedentary _____Light _____Medium _____Heavy _____Very Heavy

13. Please give an opinion of work restrictions or complete a physical capacity work restriction form. If you do not have a work restriction or physical capacities form, one can be provided to you.
14. If the patient/examinee is not capable of working in any capacity at this time, when do you anticipate releasing them for work?

15. Are breaks required during the workday? Frequency? Duration?
16. Can the patient operate a motor vehicle?

To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP

David Barrett