Common use of Care Professional Clause in Contracts

Care Professional. The following information should be completed by the Health Care Professional Please check one: Patient is capable of returning to work with no restrictions. Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Complete sections 3 and 4. Should the absence continue, updated medical information will next be requested after the date of the follow up appointment indicated in section 4. First Day of Absence: General Nature of Illness (please do not include diagnosis): Date of Assessment: dd mm yyyy 2A: Health Care Professional to complete. Please outline your patient’s abilities and/or restrictions based on your objective medical findings. PHYSICAL (if applicable) Walking: Full Abilities Up to 100 metres 100 - 200 metres Other (please specify): Standing: Full Abilities Up to 15 minutes 15 - 30 minutes Other (please specify): Sitting: Full Abilities Up to 30 minutes 30 minutes - 1 hour Other (please specify): Lifting from floor to waist: Full Abilities Up to 5 kilograms 5 - 10 kilograms Other (please specify):