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1. Doctor's Details: Full name, qualifications, practice details, and contact information of the treating physician
2. Date: Current date of letter issuance
3. Patient Information: Patient's full name, date of birth, and relevant identification details
4. Medical Condition Summary: Brief, relevant description of the medical condition affecting work capacity (maintaining appropriate privacy)
5. Work Restrictions: Specific details of work restrictions including physical limitations, environmental considerations, and time constraints
6. Duration: Clear timeframe for how long the restrictions apply, including review date if applicable
7. Professional Declaration: Statement confirming the doctor's professional assessment and signature
1. Treatment Plan Reference: Brief mention of ongoing treatment plan when relevant to work restrictions
2. Graduated Return to Work: Detailed schedule for gradually increasing work duties, used when applicable
3. Special Equipment Requirements: Specific workplace modifications or equipment needed, if any
4. Emergency Protocols: Special instructions for managing medical emergencies if condition requires
5. Additional Healthcare Provider Details: Information about other treating healthcare providers when relevant to work restrictions
1. Physical Capacity Assessment: Detailed breakdown of specific physical capabilities and limitations
2. Work Hours Schedule: Detailed timetable for restricted work hours if applicable
3. Environmental Restrictions Chart: Specific environmental factors to be avoided or managed in the workplace
Work Restrictions
Reasonable Accommodations
Essential Job Functions
Modified Duties
Physical Limitations
Review Date
Treatment Plan
Graduated Return to Work
Maximum Work Capacity
Medical Condition
Work Hours
Physical Demands
Environmental Restrictions
Workplace Modifications
Duration of Restrictions
Treating Healthcare Provider
Medical Review
Work Capacity Certificate
Occupational Restrictions
Healthcare
Mining
Construction
Manufacturing
Retail
Hospitality
Education
Transportation
Professional Services
Agriculture
Public Sector
Logistics
Information Technology
Human Resources
Occupational Health and Safety
Risk Management
Operations
Legal
Compliance
Employee Relations
Workers Compensation
Medical Services
Health and Wellbeing
Human Resources Manager
Occupational Health and Safety Manager
Return to Work Coordinator
Workers Compensation Coordinator
Risk Management Officer
Employee Relations Manager
Workplace Health and Safety Officer
HR Business Partner
Operations Manager
Line Manager
Supervisor
General Manager
Compliance Officer
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