Common use of Care Professional to complete Clause in Contracts

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): No If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 1‌ BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: (See also Letter #12 for Ministry/School Board Initatives) LETTER OF AGREEMENT #1 1‌ BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: Return to TOC Return to Key Terms LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): No If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN BETWEEN‌ The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): _ No If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ ' Associations/ Le Conseil des associations d’employeurs d'employeurs (hereinafter called ‘'CTA/CAE’') AND The Ontario Secondary School Teachers’ ' Federation/ Fédération Federation des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘'OSSTF/FEESO’')

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN BETWEEN‌ The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply Have you discussed return to work with your patient? Yes No for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): No If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: yyyy dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for Have you discussed return to work with your patient? Yes No approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 1‌ BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)

Care Professional to complete. From the date of this assessment, the above will apply for approximately: 6-10 days 11- 15 days 16- 25 days 26 + days Have you discussed return to work with your patient? Yes No Recommendations for work hours and start date (if applicable): Regular full time hours Modified hours Graduated hours Start Date: dd mm yyyy Is patient on an active treatment plan?: Yes No Has a referral to another Health Care Professional been made? Yes (optional - please specify): If a referral has been made, will you continue to be the patient’s primary Health Care Provider? No No Yes No 4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy dd Completing Health Care Professional Name: (Please Print) Date: Telephone Number: Fax Number: Signature: LETTER OF AGREEMENT #1 1‌ BETWEEN The Council of Trustees’ Associations/ Le Conseil des associations d’employeurs (hereinafter called ‘CTA/CAE’) AND The Ontario Secondary School Teachers’ Federation/ Fédération des enseignantes-enseignants des écoles secondaires de l’Ontario (hereinafter called the ‘OSSTF/FEESO’)