Forms Guidance (FMLA, Disability, etc.)

Who Can Fill In These Forms? 

Nurse Practitioners are the only providers at Thriveworks that can complete FMLA and Short Term Disability assessments/documentation. Nurse Practitioners may not complete assessments/documentation for Long Term or Permanent Disability. FMLA and Short Term Disability assessments/documentation require a minimum of four appointments with a Medication Manager. These involve an intake appointment which will take 60 minutes and a minimum of 3 follow-up appointments which will take 30 minutes per appointment.  Talk therapists may not complete any Disability or FMLA forms/assessments at this time.

What is Short Term Disability?

Short-term disability is a type of insurance that partially covers income for people who need to take time away from work because they are unable to perform job duties due to an illness or an injury.

Typically, the injuries or illnesses covered through short-term disability insurance are temporary in nature. These kinds of health conditions impact a person's occupation, such as a musician breaking their hand or a worker giving birth.

What is FMLA?

Clients are able to file for FMLA if they are unable to work due to a serious health condition. A chronic condition, whether physical or mental (e.g., anxiety, dissociative disorders), that may cause occasional periods when an individual is unable to work is a qualifying serious health condition provided  it requires treatment by a health care provider at least twice a year and recurs over an extended period of time. While short-term disability replaces a portion of the employee's income, the FMLA protects the employee's job. In fact, the FMLA provides up to 12 weeks of job-protected leave. Doctors aren't the only health care providers who may certify FMLA leave. The Department of Labor definition includes clinical psychologists, clinical social workers and nurse practitioners. Each of these providers must be licensed to practice in the state. 

What is Thriveworks’ policy on clinician completing FMLA or Short Term Disability Forms?

When a client asks you to complete these forms, the best first step would be to refer the client to their Primary Care Provider (PCP). Quite often, a client’s PCP will be in the best position to have the necessary information and knowledge about the client and their medical history to answer the questions on these forms.

What if the client asks to fill out these forms due to a mental health issue that you are treating?

Sometimes, it may feel right to fill out these forms, although we do encourage you to send them to their PCP anyway. However, if the leave or disability request is based on a mental health diagnosis, there are circumstances in which you may be the provider that has the most knowledge of the client’s diagnosis and/or limitations This will be present if you have an established relationship with the client. This means more than an intake at the least. You must feel competent in filling out the information prior to filling it out. Ultimately, we want to ensure Thriveworks clinicians are acting within their scope of practice when completing these forms and feel comfortable and capable of answering the questions. It is important to remember that there is no requirement that a clinician complete these forms. If you are the provider with the most knowledge about the client’s diagnosis, make sure a Release of Information (ROI) is on file for the client, prior to completing any forms.

What do you do if you have questions about filling out forms?

If you have any questions about the forms and are uncertain if you would be acting within your scope and competency, reach out to your RCD. They often will be able to provide you with the proper guidance and can facilitate a conversation with Legal to further discuss if unique forms or circumstances are present.

What is acting within your scope of practice?

In the situation when a client’s request is based on a mental diagnosis and you would be acting within your scope and are in the best position to answer the questions, here are a few tips.

Firstly, make sure your RCD is included in this decision to complete the forms as they can provide valuable advice when answering specific questions. In most cases clients will provide you with specific FMLA or disability forms from their employer. If asked about a client’s ability to work and/or to return to work, it is imperative that you have the requisite understanding of the client’s work and how their diagnosis impacts their ability to perform their job, 

You also may, but are not required to, provide other appropriate medical facts, including diagnosis, symptoms, or any regimen of continuing treatment such as the use of specialized equipment. Your answers to these questions should be based on previously established facts from the client’s medical record. Again, you may feel able to answer some, all or none of the questions asked of you. If you are unsure, reach out to your RCD for any necessary guidance.   

As a health care provider, you are expected to provide only your best-informed medical judgment when estimating your client’s need for leave or care if the need is unpredictable. The FMLA does not require that you are able to provide an exact schedule of your client’s health care needs – this is just an estimate. You may provide your best-informed medical opinions, so long as it is rooted in and based on the client’s medical records.

Link to FMLA Department of Labor website for more guidance and information.

What if medical records are needed to accompany the forms?

In order to send medical records along with the forms you have completed, please fill out the request here. Attach the forms you have completed and the Medical Records Team will fax over everything as needed. Please see the Medical Records page in the Legal Knowledge Base for more information.