MEDICAL LEAVE RETURN TO WORK FORM - DCH Health System 2025

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A physician release to return to work form is a document that verifies an employees fitness to resume work after a period of illness or injury. It serves as evidence that the employee is healthy enough to perform their job duties.
Here are some tips for returning to work after medical leave to help you prepare: Maintain open communication. Create a plan. Meet with HR. Ask about fitness-for-duty certifications. Inquire about changing your schedule. Thank your coworkers. Prepare for questions. Be kind to yourself.
Physician work release options include: Full work release. The doctor confirms your injuries are healed and suggests no restrictions be applied to your work duties. Essentially, the release states that you can go back to work without the need for your employer to alter your duties.
What information must be reported on Physicians Release to Return to Work Form? The form must typically include the employees name, the physicians name, the date of examination, the employees current health status, any work restrictions, and the date the employee is cleared to return to work.
Purpose of the Form: The Release to Return to Work Form must be completed when an associate is released to return to work following an absence as a result of an injury or illness.
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Medical clearance refers to a healthcare professionals assessment of an injured employees ability to return to work safely and without risk of further injury. This assessment is typically conducted by the employees treating physician, but it may also involve a specialist or a rehabilitation specialist.

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