• Comply with all the rules and regulations established by the Industrial Commission of Arizona (ICA). • Have at least one (1) board-certified Occupational Medicine Physician on staff. • Have at least one (1) medical facility located within or adjacent to the City boundaries. • Make every attempt to provide the medical report and the work status summary to the City’s Workers’ Compensation Unit within twenty-four (24) hours of the injured employee/volunteer’s first treatment visit. o The Medical Report for the Workers’ Compensation Unit shall: Provide a detailed report of the injury/illness; body part(s) involved; treatment given; referrals; and medication(s). Clearly identify the mechanism of injury and/or causation of injury, if known, and provide an explanation on how the mechanism of injury and/or causation of injury was determined. If the mechanism of injury or causation of injury is not clearly identified, known, or undetermined, then the medical report should indicate that the mechanism or causation of injury is not identified, known, or undetermined and the need for additional medical testing and/or examination or information to make that determination. For ALL acute stress and/or post-traumatic stress illnesses, the mechanism of illness and causation must be determined by a mental health professional ONLY. Document the complete medical history of prior injuries or illnesses and medications. o The Work Status Summary shall provide the status of the employee/volunteer work capability (no-work or return to regular duty or return to work with work restrictions). Please see the City’s Transitional Work Program requirements under this Agreement. The Summary shall also indicate the arrival time the employee/volunteer and the time the employee/volunteer left the facility. The Summary SHALL NOT include social security number, date of birth, diagnosis codes, description of injury/illness, or any other HIPAA protected medical health information. • Treat patients on a walk-in and appointment basis and shall specialize in occupational medical care. • Contact the Workers’ Compensation Unit to receive prior authorizations for treatment beyond the initial directed care examination. The Workers’ Compensation Unit must authorize all procedures, including referrals for specialists, physical therapy and chiropractic care; diagnostics, and surgeries. • If the physician or medical provider determines that the employee/volunteer has suffered an injury to the knee that requires an x-ray; the Provider must perform a weight bearing x-ray of the injured knee. • Defer claims of acute stress and/or post-traumatic stress conditions to mental health medical professionals for the diagnosis of and mechanism of illness/injury determination. Referrals for mental health professionals must be authorized by the Workers’ Compensation Unit. • If the injured employee/volunteer no longer requires medical care, the physician will submit the medical report with the date of discharge to the Workers’ Compensation Unit, even though the employee may require further medical care for conditions unrelated to the industrial injury. The final report and discharge date are necessary for closing the workers’ compensation claim file. • If the physician determines that the employee/volunteer has suffered permanent disability or measurable impairment, the physician must document the findings in detail; estimate the degree of disability, and forward it to the City’s Workers’ Compensation Unit. • Communicate information, at the time of initial treatment visit, on the City’s Pharmacy Benefit Manager (PBM) program and prescription services by providing employees/volunteers with the City’s First Fill letter and applicable brochures. • The City has a Transitional Work Program. If the injured employee is capable of some form of gainful employment, it is appropriate for the physician to release the injured employee to transitional (light/modified/restricted) duty.
