Common use of Multiple Treatments Clause in Contracts

Multiple Treatments. (Non-Chronic Conditions) Any period of absence to receive multiple treatments (including any period of recovery) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy) or kidney disease (dialysis). APPENDIX D Attachment B WESTERN OREGON UNIVERSITY Donated Leave Bank APPLICATION FOR ENROLLMENT FORM Employee Name: Date of Request: Department: Position: Hire Date: Phone Number: I hereby request enrollment for membership in the Western Oregon University Donated Leave Bank effective immediately. I understand that my membership in the Donated Leave Bank is subject to the terms and conditions of the collective bargaining agreement with the Union, Donated Leave Bank, and that by signing this application form, I agree to be governed by said Administrative Policy. I further authorize the Human Resources Office to deduct 8 hours of sick leave annually from my accrual account. I understand that, to continue enrollment in the Donated Leave Bank, I must donate the minimum amount of leave time determined as necessary to maintain the Leave Bank whenever there is a call for donations. This authorization shall continue from year to year unless and until I provide the Human Resources Office with written notice of my intent to discontinue membership. Date Employee Signature APPENDIX D Attachment C WESTERN OREGON UNIVERSITY Donated Leave Bank REQUEST FOR BENEFIT FORM Employee Name: Date of Request: Department: Position: Hire Date: Phone Number I hereby request hours of sick leave benefits from the Donated Leave Bank for the following reason (check one):

Multiple Treatments. (Non-Chronic Conditions) Any period of absence to receive multiple treatments (including any period of recovery) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy) or kidney disease (dialysis). APPENDIX D Attachment B WESTERN OREGON XXXXXXXX X Xxxxxxxxxx X XXXXXXX XXXXXX UNIVERSITY Donated Leave Bank APPLICATION FOR ENROLLMENT FORM Employee Name: Date of Request: Department: Position: Hire Date: Phone Number: I hereby request enrollment for membership in the Western Oregon University Donated Leave Bank effective immediately. I understand that my membership in the Donated Leave Bank is subject to the terms and conditions of the collective bargaining agreement with the Union, Donated Leave Bank, and that by signing this application form, I agree to be governed by said Administrative Policy. I further authorize the Human Resources Office to deduct 8 hours of sick leave annually from my accrual account. I understand that, to continue enrollment in the Donated Leave Bank, I must donate the minimum amount of leave time determined as necessary to maintain the Leave Bank whenever there is a call for donations. This authorization shall continue from year to year unless and until I provide the Human Resources Office with written notice of my intent to discontinue membership. Date Employee Signature APPENDIX D Attachment C WESTERN OREGON UNIVERSITY Donated Leave Bank REQUEST FOR BENEFIT FORM Employee Name: Date of Request: Department: Position: Hire Date: Phone Number I hereby request hours of sick leave benefits from the Donated Leave Bank for the following reason (check one):