Return To Work Authorization Form

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Return to work form: medical authorization name of patient: patient phone #: name & title of health care provider: physician phone#: dates of treatment/office visits: physician fax #: 1. following review of the position description, i certify that...
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What is Return To Work Authorization Form?

A Return To Work Authorization Form is a document that outlines the conditions and limitations for an employee returning to work after an injury or illness. It typically includes information about the employee's medical restrictions, accommodations needed, and any other relevant details.

What are the types of Return To Work Authorization Form?

There are several types of Return To Work Authorization Forms that may vary depending on the employer's policies and the nature of the employee's condition. Some common types include: Modified duty forms, Full duty release forms, Temporary work restriction forms, and Permanent work restriction forms.

Modified duty forms
Full duty release forms
Temporary work restriction forms
Permanent work restriction forms

How to complete Return To Work Authorization Form

Completing a Return To Work Authorization Form is a straightforward process that involves providing accurate information about the employee's medical status and any necessary accommodations. Follow these steps to complete the form: 1. Fill in the employee's personal information, 2. Specify the medical restrictions or accommodations needed, 3. Sign and date the form to confirm the information provided is accurate.

01
Fill in the employee's personal information
02
Specify the medical restrictions or accommodations needed
03
Sign and date the form to confirm the information provided is accurate

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Video Tutorial How to Fill Out Return To Work Authorization Form

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Questions & answers

Attach any existing doctor's assessment to the return to work form. Discuss any reasonable adjustments if they are still recovering, but fit to work, or if they suffer with long term effects. You need to know if any medication will affect their performance or maybe their ability to drive into work.
- You must confirm that you have returned to work on your first day back by calling the UCI Leave Service Center at 855-922-2152 or by accessing the Sedgwick Online Portal at hr.uci.edu/sedgwick.
Send your updated medical documentation or certification form to Sedgwick via regular mail, fax, email or upload to the mySedgwick portal. The current status of your leave will determine appropriate next steps with this information.
Once we receive your completed documentation, we'll make a decision within two business days. If your claim is approved, you should be able to take your leave and we won't need anything from you until you are ready to return to work. If your circumstances change during your leave, let Sedgwick know as soon as possible.
To be completed by a licensed health care provider releasing the employee to return to work following a medical absence.
Work with Sedgwick and the Accommodations Service Center at 855-489-1600 to make necessary arrangements if you are returning to work with restrictions and need special accommodations. At least three days prior to your return, fax or email the return-to-work certification form to Sedgwick.
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