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: Fewer than 6 6 - 10 days 11- 15 days 16- 25 days 26 + days Permanently 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 Please check one: Patient is capable of returning to work with no restrictions. Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Should the absence continue, updated medical information may be requested after the date of the follow up appointment indicated in section 4. 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 Ontario Council of Educational Workers (Hereinafter ‘OCEW’) AND The Council of Trustees Associations (Hereinafter The ‘CTA’) RE: Job Security The parties acknowledge that education workers contribute in a significant way to student achievement and well-being.

Care Professional to complete. From the date of this assessment, the above will apply for approximately: Fewer than 6 6 - 10 days 11- 15 days 16- 25 days 26 + days Permanently 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 Please check one: Patient is capable of returning to work with no restrictions. Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Should the absence continue, updated medical information may be requested after the date of the follow up appointment indicated in section 4. 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 1‌ BETWEEN‌ The Ontario Council of Educational Workers (Hereinafter ‘OCEW’) AND AND‌ The Council of Trustees Associations (Hereinafter The ‘CTA’) RE: RE:‌ Job Security The parties acknowledge that education workers contribute in a significant way to student achievement and well-being.

Care Professional to complete. From the date of this assessment, the above will apply for approximately: ☐ Fewer than 6 ☐ 6 - – 10 days 11- ☐ 11 – 15 days 16- ☐ 16 – 25 days 26 ☐ 26+ days ☐ Permanently 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 Please check one: ☐ Patient is capable of returning to work with no restrictions. ☐ Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 ☐ I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Should the absence continue, updated medical information may be requested after the date of the follow up appointment indicated in section 4. 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 Ontario Council of Educational Workers (Hereinafter ‘OCEW’) AND The Council of Trustees Associations (Hereinafter The ‘CTA’) RE: Job Security The parties acknowledge that education workers contribute in a significant way to student achievement and well-beingwell‐being.

Care Professional to complete. From the date of this assessment, the above will apply for approximately: ☐ Fewer than 6 ☐ 6 - 10 days ☐ 11- 15 days ☐ 16- 25 days ☐ 26 + days ☐ Permanently 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 Please check one: ☐ Patient is capable of returning to work with no restrictions. ☐ Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 ☐ I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Should the absence continue, updated medical information may be requested after the date of the follow up appointment indicated in section 4. 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 Ontario Council of Educational Workers (Hereinafter ‘OCEW’) AND The Council of Trustees Associations (Hereinafter The ‘CTA’) RE: Job Security The parties acknowledge that education workers contribute in a significant way to student achievement and well-being.

Care Professional to complete. From the date of this assessment, the above will apply for approximately: Fewer than 6 6 - 10 days 11- 15 days 16- 25 days 26 + days Permanently 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 Please check one: Patient is capable of returning to work with no restrictions. Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3 I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work at this time. Should the absence continue, updated medical information may be requested after the date of the follow up appointment indicated in section 4. 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 Ontario Council of Educational Workers Workers‌ (Hereinafter ‘OCEW’) AND The Council of Trustees Associations RE:‌‌ Job Security (Hereinafter The ‘CTA’) RE: Job Security The parties acknowledge that education workers contribute in a significant way to student achievement and well-being.