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Physician release to return to work form

Medical release to return to work 2012 form-2026

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The document is a Return to Work Release Form for employees at The University of Texas at Austin, which must be completed by both the employee and their healthcare provider. It outlines the process for returning to work after a medical leave, including any restrictions related to the employee's condition. The form ensures that supervisors receive necessary information while minimizing the release of medical details. It also includes guidelines regarding workplace accommodations under the ADAAA and compliance with GINA.

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Click ‘Get Form’ to open the medical release to return to work 2012 form in the editor.
Begin by filling in your personal details in the 'TO BE COMPLETED BY THE EMPLOYEE' section. Enter your name, UT EID, shift, department, and contact numbers.
Sign the form at the bottom of this section and indicate your last day worked along with the date of signing.
Move to the 'TO BE COMPLETED BY THE HEALTHCARE PROVIDER' section. The healthcare provider should indicate whether the condition is work-related and provide a return date with or without restrictions.
Fill out any applicable work restrictions, including maximum lifting and pushing/pulling weights, as well as any other specific limitations.
Ensure that the healthcare provider signs and provides their contact information before submitting it to your supervisor.

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