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This document is used to obtain the necessary information from both the staff member and the attending physician for the Catastrophic Leave Sharing Program at Carleton College, confirming a patient's
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How to fill out catastrophic leave sharing program
How to fill out CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT
01
Begin with the patient's name and identification details at the top of the form.
02
Fill in the attending physician's name, contact information, and medical license number.
03
Provide the patient's medical diagnosis and a brief description of their condition.
04
Specify the expected duration of the patient's medical condition and any necessary treatments.
05
Indicate if the patient's condition is likely to impair their ability to perform job-related duties.
06
Document any recommendations for accommodations or modifications to the patient's work environment, if applicable.
07
Sign and date the statement to certify its accuracy.
Who needs CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
01
Employees who are facing a serious medical condition or illness that requires extended leave.
02
Individuals seeking assistance through the Catastrophic Leave Sharing Program due to financial hardship from medical issues.
03
Caregivers of employees with serious health concerns who need to provide medical documentation for leave.
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People Also Ask about
What is the catastrophic leave program at UCLA?
The UCLA Campus Catastrophic Leave Program provides temporary salary and benefit continuation for a staff employee who accrues vacation and who has exhausted all paid leave accruals to address a personal disaster such as: the employee's catastrophic illness or injury; care of a catastrophically ill or injured family
What is catastrophic leave in California?
Catastrophic leave for a natural disaster/state of emergency is leave for an employee whose principal residence is located in a county where a state of emergency has been declared by the Governor, is unable to work due to the effect of the natural disaster/state of emergency on the recipient employee 's principal
What is the sabbatical leave for Cal Poly?
Sabbatical Leave Compensation on Semesters The faculty contract allows 12-month faculty to remain in 12-month status while on sabbatical. Sabbatical leave compensation for 12-month employees during semesters is: four months at full salary; or. eight months at one-half salary.
What is medical leave for Cal Poly?
The California State University Family Medical Leave (CSU FML) incorporates both the FMLA and CFRA leaves. CSU FML entitlement is for up to 12 weeks in a 12-month period for eligible employees, calculated on a 12-month period measured forward from the first date an employee takes CSU FML.
What is catastrophic leave for Cal Poly?
Donated leave may be used by an employee who has a catastrophic illness or injury, is impacted by a natural disaster, state of emergency as deemed by the State of California governor, or need to care for a qualified family member and has exhausted all types of pay normally available to cover the required absence from
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What is CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
The CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT is a document completed by a physician to certify the medical condition of an employee applying for leave under the CLSP, ensuring they qualify for shared leave benefits due to a catastrophic health issue.
Who is required to file CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
Employees who wish to apply for catastrophic leave benefits under the CLSP must file an ATTENDING PHYSICIAN'S STATEMENT to confirm their medical condition necessitating the leave.
How to fill out CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
To fill out the ATTENDING PHYSICIAN'S STATEMENT, the physician must provide detailed information about the employee's medical diagnosis, treatment plan, prognosis, and justification for the need for leave, while ensuring accuracy and completeness in the provided information.
What is the purpose of CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
The purpose of the ATTENDING PHYSICIAN'S STATEMENT is to provide verification and medical documentation necessary for employees to access benefits under the CLSP, facilitating support during times of severe health challenges.
What information must be reported on CATASTROPHIC LEAVE SHARING PROGRAM (CLSP) ATTENDING PHYSICIAN'S STATEMENT?
The information that must be reported includes the employee's medical diagnosis, the severity of the condition, the anticipated duration of incapacity, treatment details, and any other relevant medical factors affecting the employee's ability to work.
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