Edit, Download, and Sign the Attending Physician Statement - St. Joseph's Healthcare
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How do I fill this out?
Filling out this form requires careful attention to detail. Begin by providing your personal information and acknowledging consent. Ensure all sections are complete to expedite the approval process.
How to fill out the Attending Physician Statement - St. Joseph's Healthcare?
1
Download the form from the provided link.
2
Complete your personal information in Section A.
3
Physician must fill out Section B with necessary details.
4
Sign the consent section to allow information sharing.
5
Submit the completed form to your Occupational Health Office.
Who needs the Attending Physician Statement - St. Joseph's Healthcare?
1
ONA employees with medical absences for verification.
2
HR departments to track employee absence and compliance.
3
Healthcare providers for submitting treatment details.
4
Disability Management Coordinators for overseeing cases.
5
Union representatives to support members' cases.
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What are the instructions for submitting this form?
Submit the completed Attending Physician Statement via email at hoffice@stjoes.ca or fax to 905-521-6111. For postal submissions, send to: Occupational Health & Safety Services, Charlton Campus, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6. Always keep a copy of the submitted document for your records.
What are the important dates for this form in 2024 and 2025?
For 2024, ensure to submit your APS every two weeks unless otherwise notified. Important reminders may include dates related to employment policies or health benefits changes.
What is the purpose of this form?
The Attending Physician Statement serves as a critical document for employees needing to prove their medical condition. It ensures that both management and the employee are aligned on health matters and supporting work absence. Proper submission of this form facilitates the employee's eligibility for necessary benefits during their recovery.
Tell me about this form and its components and fields line-by-line.
- 1. Employee Information: Collects personal details including name, job title, and DOB.
- 2. Consent: Important consent section for information sharing.
- 3. Physician's Instructions: Details from the physician regarding the employee's condition and capabilities.
- 4. Functional Limitations: Specifies any physical limitations affecting the employee's return to work.
- 5. Signature and Contact: Requires the physician's signature and details along with the employee's.
What happens if I fail to submit this form?
If this form is not submitted, employees risk not receiving their salary replacement benefits. Additionally, absence could be marked as unexcused, affecting employment records. It is crucial to adhere to submission timelines to avoid complications.
- Benefit Denial: Failure to submit may lead to automatic denial of salary replacement.
- Unexcused Absences: Without proper documentation, absences may be flagged as unexcused.
- Extended Recovery Time: Without timely submission, the recovery process could be prolonged.
How do I know when to use this form?
- 1. During Medical Leave: To verify and support your absence from work due to medical issues.
- 2. When Switching Duties: To inform the employer about any needed workplace accommodations.
- 3. For Insurance Claims: To substantiate claims for medical treatment or disability.
Frequently Asked Question
What is the purpose of the Attending Physician Statement?
This statement validates an employee's medical condition for absence.
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Can I share this document?
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What information do I need to complete?
Make sure to fill sections A and B, including consent and physician details.
Is there a specific format for submitting this form?
You can submit it via email, fax, or in person at the specified offices.
How often do I need to provide this form?
The form must be submitted every two weeks during your medical absence.
Who should fill out section B?
A qualified physician must complete section B accurately.
What happens if I don’t submit the form?
Failure to submit may result in loss of salary replacement benefits.
Can I download the completed PDF?
Yes, you can download the edited PDF directly after making changes.
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