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Certification Dr. Mary M.Cuthbert. Illness certification Legally a doctor is required to issue a statement of incapacity for work due to illness ONLY.

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Presentation on theme: "Certification Dr. Mary M.Cuthbert. Illness certification Legally a doctor is required to issue a statement of incapacity for work due to illness ONLY."— Presentation transcript:

1 Certification Dr. Mary M.Cuthbert

2 Illness certification Legally a doctor is required to issue a statement of incapacity for work due to illness ONLY if it lasts more than seven days(including Sunday) Legally a doctor is required to issue a statement of incapacity for work due to illness ONLY if it lasts more than seven days(including Sunday) This is known,in laymans terms,as a sick note This is known,in laymans terms,as a sick note

3 Self-certification of Illness Patients should self-certify for the first 7 days of illness Patients should self-certify for the first 7 days of illness Form SC2 is the standard form used,but some employers use their own unique forms to notify sickness Form SC2 is the standard form used,but some employers use their own unique forms to notify sickness Form SC1 is used by the self-employed and unemployed Form SC1 is used by the self-employed and unemployed

4 Doctors sick note when patient off work less than one week Med 3 can only be issued if patient has been off work more than 7 days Med 3 can only be issued if patient has been off work more than 7 days A private sick note can be given if a patient is off work less than 7 days.This can be charged for. A private sick note can be given if a patient is off work less than 7 days.This can be charged for. Sick notes are legal documents –a doctor may be accused of fraud if he bends the rules Sick notes are legal documents –a doctor may be accused of fraud if he bends the rules

5 Westcliffe Medical Centre, Westcliffe Rd. Shipley West Yorkshire Dear Employer, You have requested a doctors statement for the first seven days of an employees sickness. I wish to refer you to the Statutory Sick Pay Manual for Employers –National Insurance Contributions Series CA30, Paragraph 28, which states: ……you (the employer) cannot ask for a doctors statement for the first seven days of a spell of sickness. The purpose of this regulation is to avoid the necessity for employees with minor, self-limiting illness or injury to use surgery appointments for the sole purpose of obtaining a medical certificate. We do not, therefore, issue certificates in these circumstances. If employers have reason to enquire about a spell of sickness, they are advised to write to the doctor, including written permission from the employee concerned, when a report may be issued. A charge will be made to you, the employer, for provision of such a report, The Doctors, Westcliffe Medical Centre BD18 3EE

6 Issuing a sick note without seeing the patient A Med 3 CANNOT be given without seeing the patient A Med 3 CANNOT be given without seeing the patient A Med 5 can be given in certain circumstances A Med 5 can be given in certain circumstances - If patient has been seen previously but no sick note - If patient has been seen previously but no sick note was issued at that consultation was issued at that consultation - If patient has an open note and now requires a - If patient has an open note and now requires a return to work note return to work note - If there is a report from another doctor,issued less - If there is a report from another doctor,issued less than a month ago,stating patient is not fit to work. than a month ago,stating patient is not fit to work. In this situation Med5 should be for 1 month or less In this situation Med5 should be for 1 month or less

7 General Rules about Sick Notes Should be completed in ink and signed by a medical practitioner (other than the patient) ie doctor cannot certify self Should be completed in ink and signed by a medical practitioner (other than the patient) ie doctor cannot certify self Should be issued once only; replacements should be marked Duplicate Should be issued once only; replacements should be marked Duplicate Should be used for Social Security purposes only Should be used for Social Security purposes only

8 The statement must contain: The patients name The patients name Date of examination on which statement is based Date of examination on which statement is based Diagnosis of condition(see also Med6) Diagnosis of condition(see also Med6) Date statement issued Date statement issued Address of doctor Address of doctor Signature of doctor Signature of doctor

9 Which Sick notes are used most commonly? Med 3 Med 3 Med 5 Med 5 Med 4 Med 4

10 Med 3 The doctor must examine the patient on the day,or day before,the statement is issued The doctor must examine the patient on the day,or day before,the statement is issued Med 3 can be for a closed or openperiod of incapacity Med 3 can be for a closed or openperiod of incapacity Note the remarks section Note the remarks section

11 Closed Med 3 In this situation doctor completes the until section,giving a specific date to return to work In this situation doctor completes the until section,giving a specific date to return to work The date specified may be up to 14 days from date of issue The date specified may be up to 14 days from date of issue

12 Open Med 3 A specific date is not entered but a time period eg 2 weeks A specific date is not entered but a time period eg 2 weeks This implies that patient will be reviewed after that period has elapsed This implies that patient will be reviewed after that period has elapsed If patients condition and prognosis are uncertain and an open Med 3 has been issued,patient needs to be reviewed and a closed Med 3 issued before resuming work If patients condition and prognosis are uncertain and an open Med 3 has been issued,patient needs to be reviewed and a closed Med 3 issued before resuming work

13 0pen Med 3- rules re length of sick leave 0pen Med 3- rules re length of sick leave Med 3 can be issued for up to one month initially Med 3 can be issued for up to one month initially A doctor cannot issue a Med 3 for more than 6 months within the first 6 months of incapacity A doctor cannot issue a Med 3 for more than 6 months within the first 6 months of incapacity After the first 6 months of incapacity a Med 3 can be issued for any clinically appropriate period up to indefinite After the first 6 months of incapacity a Med 3 can be issued for any clinically appropriate period up to indefinite

14 Med 3 – Remarks section Can be used if patient fit to return to work in limited capacity eg should avoid heavy lifting Can be used if patient fit to return to work in limited capacity eg should avoid heavy lifting Can be used to recommend a workplace assessment eg ergonomic assessment recommended Can be used to recommend a workplace assessment eg ergonomic assessment recommended Can be used to recommend phased return to work Can be used to recommend phased return to work

15 Med 5 Med 5 should be used in exceptional circumstances Med 5 should be used in exceptional circumstances It is better for same doctor to see a patient throughout period of incapacity so that Med 3s can be issued It is better for same doctor to see a patient throughout period of incapacity so that Med 3s can be issued

16 Med 5 Med 3 can only be issued if patient is seen on day,or day before,issue Med 3 can only be issued if patient is seen on day,or day before,issue There may be times when doctor needs to supply evidence of incapacity for an earlier period.Med 5 may be used if conditions below are fulfilled There may be times when doctor needs to supply evidence of incapacity for an earlier period.Med 5 may be used if conditions below are fulfilled

17 Med 5 – criteria for issue Med 5 can be based on your examination of patient on a previous occasion(if Med3 not issued at the time) Med 5 can be based on your examination of patient on a previous occasion(if Med3 not issued at the time) Doctor must be sure that s/he would have advised patient to refrain from work for the whole period in question Doctor must be sure that s/he would have advised patient to refrain from work for the whole period in question Only exception is when report from another doctor is basis of evidence Only exception is when report from another doctor is basis of evidence

18 Med 5-using another doctors report as basis of evidence The other doctors report must have been issued less than a month before The other doctors report must have been issued less than a month before The Med 5 issued cannot cover a forward period more than 1 month The Med 5 issued cannot cover a forward period more than 1 month Therefore if you(the issuing doctor) did not examine the patient at the start of the backdated period, you cannot issue a Med 5 unless patient was seen by another doctor and his report was issued less than a month ago Therefore if you(the issuing doctor) did not examine the patient at the start of the backdated period, you cannot issue a Med 5 unless patient was seen by another doctor and his report was issued less than a month ago

19 Definition of report from another doctor A reasonably completed hospital discharge summary A reasonably completed hospital discharge summary A hospital letter A hospital letter Your partners contemporaneous records from a previous consultation Your partners contemporaneous records from a previous consultation

20 What if patient hasnt been seen in last month? Patient needs to be seen and examined Patient needs to be seen and examined Med 3 can be issued for an appropriate forward period Med 3 can be issued for an appropriate forward period Comments can be made eg the patient tells me he has been unfit since… Comments can be made eg the patient tells me he has been unfit since…

21 Med 4-when is it used and why? When patient has been off work for 26 weeks When patient has been off work for 26 weeks Requested by Dept for Work and Pensions Requested by Dept for Work and Pensions Patient receives letter from DWP advising that Personal Capability Assessment is to be applied Patient receives letter from DWP advising that Personal Capability Assessment is to be applied Patient has to complete a long questionnaire and obtain Med 4 from GP,then submit them together Patient has to complete a long questionnaire and obtain Med 4 from GP,then submit them together

22 Med 4- what it should include Diagnosis of main incapacitating condition Diagnosis of main incapacitating condition Other relevant conditions Other relevant conditions In the doctors remarks section details of disabling effects,treatment,prognosis and ability to travel to an assessment medical examination In the doctors remarks section details of disabling effects,treatment,prognosis and ability to travel to an assessment medical examination Advice regarding patients ability to carry out his usual occupation Advice regarding patients ability to carry out his usual occupation

23 What is the point of Med 4? Helps provide evidence to DWP for patients with severe conditions who may be exempted from need to send in further sick notes Helps provide evidence to DWP for patients with severe conditions who may be exempted from need to send in further sick notes If Med 4 corresponds with patients account of their disability,may not need an examination If Med 4 corresponds with patients account of their disability,may not need an examination If completed thoroughly Med 4 helps to reduce need for appeals if benefit disallowed If completed thoroughly Med 4 helps to reduce need for appeals if benefit disallowed

24 Med 6 There may be exceptional circumstances where a full,accurate diagnosis could be prejudicial to patients wellbeing eg AIDS There may be exceptional circumstances where a full,accurate diagnosis could be prejudicial to patients wellbeing eg AIDS Dont forget Med 3 and Med 5 certificates are passed by patients to their employers,who may not treat information as confidential Dont forget Med 3 and Med 5 certificates are passed by patients to their employers,who may not treat information as confidential Med 6 is not passed to employer but goes straight to DWP Med 6 is not passed to employer but goes straight to DWP

25 Med 6 To be used if doctor has been unable to enter a precise diagnosis on Med 3,Med 4 or Med 5 To be used if doctor has been unable to enter a precise diagnosis on Med 3,Med 4 or Med 5 Med 6 should be sent direct to DWP office Med 6 should be sent direct to DWP office A Med 6 is included in each pad of sick notes A Med 6 is included in each pad of sick notes DWP will request a short report from GP DWP will request a short report from GP An accurate diagnosis must be entered on Med 6 so the DWP medical officer has a realistic idea of patients true condition An accurate diagnosis must be entered on Med 6 so the DWP medical officer has a realistic idea of patients true condition

26 And now……. A few cases to test your understanding! A few cases to test your understanding! In the following situations,which certificate should you issue? In the following situations,which certificate should you issue?

27 Case 1: 35 year old man, seen in surgery having developed acute low back pain when lifting a crate at work today 35 year old man, seen in surgery having developed acute low back pain when lifting a crate at work today Usually fit and healthy Usually fit and healthy Heavy job Heavy job

28 Case 2: 45 year old woman,underwent hysterectomy 10 weeks ago 45 year old woman,underwent hysterectomy 10 weeks ago Sick note given by hospital for 8 weeks Sick note given by hospital for 8 weeks Saw consultant in OPD 3 weeks ago and forgot to get a sick note Saw consultant in OPD 3 weeks ago and forgot to get a sick note Wants to return to work in 6 weeks from now Wants to return to work in 6 weeks from now

29 Case 3: 21 year old man,phones to speak to you 21 year old man,phones to speak to you He wants a sick note for 2 weeks for his bad back He wants a sick note for 2 weeks for his bad back He has not consulted a doctor during this period He has not consulted a doctor during this period

30 Case 5: 52 year old patient with depression 52 year old patient with depression Patient has been seeing your partner for 6 months with this condition and is still unfit to work.She needs another sick note Patient has been seeing your partner for 6 months with this condition and is still unfit to work.She needs another sick note Your partner has just gone on holiday but did see the patient 3 weeks ago Your partner has just gone on holiday but did see the patient 3 weeks ago What if your partner had seen the patient 6 weeks ago? What if your partner had seen the patient 6 weeks ago?

31 Case 6: 40 year old woman for whom you have previously issued a Med 3 when she had a breast biopsy 40 year old woman for whom you have previously issued a Med 3 when she had a breast biopsy Med 3 now due to expire Med 3 now due to expire She is about to embark on chemotherapy and radiotherapy which will take at least 9 months to complete She is about to embark on chemotherapy and radiotherapy which will take at least 9 months to complete

32 Case 7: 45 year old man who has been off work for 3 days with D&V 45 year old man who has been off work for 3 days with D&V Asking for a sick note as employer insists he has to produce a sick note after 3 days sick leave Asking for a sick note as employer insists he has to produce a sick note after 3 days sick leave

33 Case 8: A young offender attends surgery requesting a sick note as he had D&V last week and was unable to complete his community service A young offender attends surgery requesting a sick note as he had D&V last week and was unable to complete his community service He has not been seen by a doctor during the period in question He has not been seen by a doctor during the period in question

34 Case 9 A 38 year old patient has recently been diagnosed with Hepatitis C following an admission with acute jaundice. A 38 year old patient has recently been diagnosed with Hepatitis C following an admission with acute jaundice. It is the first time you have seen the patient during this illness but you have received a letter from the consultant gastroenterologist It is the first time you have seen the patient during this illness but you have received a letter from the consultant gastroenterologist

35 Case 10: You have been seeing this patient regularly since he fractured his tibia and fibula in a RTA. You have been seeing this patient regularly since he fractured his tibia and fibula in a RTA. You saw him in surgery 2 weeks ago but did not issue a certificate You saw him in surgery 2 weeks ago but did not issue a certificate He phones you today to say that his sick note expired a week ago He phones you today to say that his sick note expired a week ago What if he attended surgery instead? What if he attended surgery instead?

36 Case 11: Patient phones you to inform you that work has lost the Med 3 you issued her 2 weeks previously Patient phones you to inform you that work has lost the Med 3 you issued her 2 weeks previously She wants another sick note She wants another sick note

37 Case 12: Patient has been off work with sciatica and has an open Med 3 for 8 weeks Patient has been off work with sciatica and has an open Med 3 for 8 weeks He attends surgery to inform you that he now feels ready to return to work (before the 8 week period has elapsed) He attends surgery to inform you that he now feels ready to return to work (before the 8 week period has elapsed)


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