Department of Orthopaedics: Policy on Patient Medical Leave Request Forms

Unit Policy

Title

Department of Orthopaedics: Policy on Patient Medical Leave Request Forms

Introduction

Purpose

The purpose of this policy is to define the requirements for Processing FMLA/Disability Forms.

Scope

This policy applies to all Department of Orthopaedics faculty, clinical nurses, and Admin Support Associates (ASA).

Policy

Policy Statement

Employees must complete all requests for medical leave forms (including FMLA, Short Term Disability and Return to Work Forms) within five business days.

All medical leave forms will be held on file for three years.

Clinical Staff

The clinical staff member assigned to the provider will be responsible for completing demographic information on medical leave-related forms, and for obtaining narratives and signatures from the providers.

The nurse will:

  1. Collect medical leave forms from the patient or Admin Support Associate
  2. Complete demographic or other clinically relevant information on the form, under the protocol established between the individual nurse and provider
  3. Deliver the forms to the provider either in the clinic or the providers office for review and signature
  4. Collect the completed forms from the provider and deliver to the Admin Support Associate for filing

Admin Support Associate (ASA)

The Admin Support Associate is responsible for providing medical leave forms to the appropriate physician’s clinical team folder, collating, and electronically filing completed medical leave forms, and responding to patient calls regarding the forms process.

The ASA will:

  1. Deliver all forms requests received from patients via mail, fax, email, or other delivery methods to the physical folder in MyShares for the provider’s clinical team.
  2. Upon receipt of completed forms from the nurses, the Admin Support Associate will deliver a copy to the patient (unless the nurse has already done so)
  3. The Admin Support Associate will electronically scan the document and save a copy to MyShares or in the patients Epic Chart.
  4. The Admin Support Associate will answer any questions regarding the process of completing medical leave forms, including questions about forms locations, completion status, initiation requests, and copies.

Contact Information

Primary Contact

Name: James O. Sanders, MD - Chair of Orthopaedic Surgery

Telephone: 919-966-9072

Email: james_sanders@med.unc.edu

Other Contacts

Name: Paul Marini, MHA, FACHE - Associate Chair of Administration

Telephone: 919-843-9382

Email: Paul_Marini@med.unc.edu

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