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MEDICAL RELEASE TO RETURN TO WORK
Physicians are advised that Abilities of Northwest Jersey, Inc.is an employment and vocational rehabilitation center. Consumers are expected to come to work physically prepared to work and must be able to tolerate long periods of standing or sittingas well as van pooling, prolonged commute or public transportation to and from work.
I, ______have read the above notice.
Print Physician’s Name
______has been under my care from ______
Print Patient’s Name Date
to ______for______
Date Condition / Illness
and is medically released to return to work without limitations on______.
Date
______
Physician’s Signature Date
______
Practice
______
Phone number
CC: Abilities RN
264 Route 31 North · PO Box 251 · Washington, New Jersey 07882
RETURN TO WORK POLICY
Individuals, who are ill, recently hospitalized or those who have undergone any invasive diagnostic or surgical procedures including dental surgery must remain at home until they are physically able to tolerate the demands of their work program AND POSE NO HEALTH RISK TO THEMSELVES OR OTHERS. Individuals are expected to come to work physically prepared to work and must be able to tolerate long periods of standing or sitting as well as van pooling, prolonged commutes or public transportation to and from work.
Individuals and caregivers are reminded that a Doctor’s Note is required before anindividual will be permitted to return to program in the following instances:
- Recent confirmed or suspected communicable disease
- Following an absence of 5 consecutive days or more
- Following hospitalization of any duration
- When an individual is sent home due to suspected communicable infection / condition, injury or any other medical condition that warrants a physician’s appointment
- Following any illness, condition or injury requiring evaluation in an emergency room, (Emergency room discharge plans that include indications when a consumer may resume normal activities are acceptable)
- Following any surgical procedures including same day procedures
- Any invasive diagnostic testing including but not limited to biopsies and spinal tap (Routine blood testing is exempt from this requirement)
- Any suspected or confirmed bone fracture
- Any suspected or confirmed sprain requiring splinting
- Any surgical, diagnostic, therapeutic, medical or dental procedure for which the consumer required sedation or general anesthesia
Abilities Agency RN and/or program supervisors retain the right to request an IDT for any consumer who has been absent from program due to a known recent medical change, recent hospitalization or rehabilitation/nursing home discharge.
The program supervisor and Agency RN must be made aware of any plans for return to program by the group home manager/coordinator, caregiver, or legal guardian at least one week in advance so that an IDT meeting can be arranged.
The purpose of an IDT meeting prior to returning to program will ensure that the needs of the individual will be met while at program and that the individual is appropriately placed in an Abilities program that can service their needs. This IDT meeting will also serve as a cooperative open communication forum so that all parties involved with the individual’s care is one that will prevent unnecessary miscommunication, and enhance the individual’s overall well-being.
Individuals who return to work without the appropriate medical releases WILL BE SENT HOME. DDD incident reports will be completed whenever circumstances create suspicion of medical neglect.
264 Route 31 North · PO Box 251 · Washington, New Jersey 07882
September 28, 2018
Attention: Caregivers and Service Recipients,
Subject: Revised Return to work policy
Attached to this notice is Abilities’ revised Medical Release To Return To Work Form. On the reverse of this form is our return to work policy. Please read and familiarize yourself with this policy and make copies of the attached form for your use whenever a doctor’s note is required as outlined in the policy.
Please note the following revision:
The Division of Developmental Disabilities Standards for Adult Day Programs requires an IDT for any individual returning after a prolonged absence, which will address a plan to include timelines, to facilitate the individual’s return.
Caregivers are once again reminded that individuals need time to recuperate following acute illness, hospitalization and significant injury. Please refrain from sending your individual to work until fully recuperated.
Please complete the section below and return to your day program supervisor.
Return this portion to the Day Program. Thank you.
I acknowledge that I have received, read and understand Abilities’ Return to Work Policy attached to this notice.
Individual’s Name (print)
Caregiver’s Name (print)
______
Caregiver Signature Date
264 Route 31 North · PO Box 251 · Washington, New Jersey 07882
1/05 med 005
rev: 7/08, 4/09, 9/12, 02/16