ELLIS CLINIC MEDICAL FORM GUIDE
More Than Filling In Boxes
The form organizes information, but the strength of the medical evidence depends on the diagnosis, objective findings, work relationship, disability or restrictions, and the physician's reasoning.
What Can the Employee Do?
The practical focus is function: what activities can be performed, what activities are limited, and for how long.
Restrictions Need Specificity
Useful restrictions describe measurable limits rather than simply saying 'light duty' or 'no heavy work.'
Not Usually the Whole Medical Case
DOL's procedure manual describes CA-17 reports as generally supplemental because they often do not address all medical issues, including causal relationship.
MEDICAL CAUSATION →THE MEDICAL LOGIC
Diagnosis → Functional Loss → Specific Restrictions
A restriction is most useful when the physician can connect it to the diagnosed work-related condition and describe the employee's actual functional capacity.
01CONDITIONIdentify the medical condition affecting work capacity.
02FUNCTIONDetermine what movements or activities are limited.
03LIMITSState specific restrictions, tolerances, or prohibited activities.
04DURATIONIndicate expected duration and reassessment when appropriate.
Important: DOL states employees should arrange for their physician to advise the employing agency of physical limitations due to the injury, and Form CA-17 is generally used for that purpose. If suitable work is available within medically supported restrictions, FECA return-to-work rules may apply.
RELATED OWCP MEDICAL FORMS