From: ‘Working is out of the question’: a qualitative text analysis of medical certificates of disability
National Insurance (NAV) | |
Medical certificate for work incapacity | |
The physician is to send this to the local NAV office. | |
0 | This certificate concerns: |
0.1 | Assessment of work capacity at sick leave |
0.2 | Rehabilitation money |
0.3 | Disability pension |
1.0 | Information about the patient and employment |
Name: | |
Year of birth: | |
Certificate written: date | |
Employer’s name and address: | |
2 | Information of diagnosis and disease |
2.1 | Main diagnosis |
2.1.1 | Code of diagnosis |
2.2 | Additional diagnosis |
2.2.1 | Code of diagnosis |
2.3 | Classification: ICPC-2/ICD-10 |
2.4 | Completely incapacitated since |
2.5 | Story of disease, symptoms and treatment |
2.6 | Current clinical status (specify date). The results of relevant investigations |
2.7 | Should NAV consider this to be: |
2.7.1. | Occupational disease? (Yes/No) |
2.7.2. | If yes: date of injury |
3 | Plan for medical examination and treatment |
3.1 | Is the patient referred for |
Medical assessment (specify)? | |
Medical treatment (specify)? | |
3.1.1 | Date of referral for medical assessment. 3.1.2 Expected waiting time (weeks) |
3.1.3 | Date of referral for medical treatment. 3.1.4 Expected waiting time (weeks) |
3.2 | Plan for medical examination. Specify the planned examination and time duration. |
3.3 | Plan for medical treatment.Specify the planned treatments and time/duration |
3.4 | Re-evaluation of previous plan of examination and treatment |
3.5 | When should the NAV office request new medical information regarding work clarification and treatment programme? |
3.6 | If further treatment is not relevant, give justification |
4 | Proposed measures beyond medical treatment |
Are the following measures applicable, on a medical basis. Yes/No | |
If yes, which ones? a) reference to specialist, b) transport subsidy, c) graded sick leave, d) technical aids, f) unemployment benefit, g) others – which ones? Give supplementary information. | |
Are there any specific considerations to be made as to these measures? | |
If no, give justifications | |
5 | Medically reasoned assessment of work ability |
5.1 | Describe how the patient's functionality is generally reduced because of disease. |
5.2 | Is the patient engaged in paid work or domestic work, a student, other? |
Specify: | |
Briefly describe the type of work and the requirements: | |
5.3 | Assessment of working capacity |
Will the patient be able to | |
a) Resume the earlier work (No/Yes)? If yes: now/after treatment | |
b) Take other work | |
5.4 | a) What is it that the patient cannot do in the present work? |
b) What other possible considerations need to be taken regarding the choice of another profession/work? | |
6 | Prognosis |
a) Is the treatment assumed to produce an improved ability to work? Yes/No | |
b) Estimate the duration of the illness/injury. | |
c) Estimate the duration of the functional disability. | |
d) Estimate the duration of the reduced working capacity. | |
7 | Causation |
Estimate the importance of the functional disability for the reduced working capacity. | |
8 | Optional information |
9 | Co-operation/Contact |
Select those that should be contacted by the NAV office: The doctor/employer/NAV/others | |
10 | Reservations |
10.1 | Is there anything in the certificate that the patient, for medical reasons, should not know? If yes, specify what the patient should not know. |
11 | The physician’s signature, etc. |
11.1 | Date, the physician’s name and address |
11.2 | The physician’s signature |
11.3 | Telephone number |