Injury management forms

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• Application fee for initial approval as a Comcare rehabilitation provider $2000
  
  

  Applications for approval as a rehabilitation provider (workplace rehabilitation provider) must be accompanied by the prescribed fee of $2000.

  
  

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• Application for approval as a Workplace Rehabilitation Provider
  
  

  This application form is to be completed by applicants seeking approval to become a rehabilitation program provider (workplace rehabilitation provider) under that Safety, Rehabilitation and Compensation Act (1988).

  
  

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• Case Conference request form
  
  

  The purpose of a case conference is for Comcare and key stakeholders to discuss strategies to return injured employees back to work as quickly, safely and effectively as possible.

  Case conferences can be initiated either by the employee, employer or Comcare. They may be held face-to-face, by phone, via video conference, or a combination of these, and are either held at routine intervals or when particular issues arise.

  This form is used to request a case conference with Comcare.
  

  
  

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• Certification of Compliance with the Guidelines for Rehabilitation Authorities 2012
  
  Rehabilitation authorities must complete a Certificate of Compliance to verify that an audit has been undertaken of its rehabilitation management system. This is required under the Guidelines for Rehabilitation Authorities 2012—see Chapter 5—Performance Assessment and Reporting.
  
  

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• Comcare workplace rehabilitation provider (consultant) approval
  
  

  This form is to be used by workplace rehabilitation provider (WRP) organisations seeking initial approval of consultants, or recognition/transfer of that approval from another Comcare WRP organisation.

  
  

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• Comcare workplace rehabilitation provider request to operate in an additional state
  
  

  This form is to be used by workplace rehabilitation provider (WRP) organisations seeking to provide SRC Act rehabilitation program services in an additional state.

  
  

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• Multiple claim case conference request form
  
  

  In certain circumstances, such as part of an agreed premium reduction strategy, discussion of a number of claims for a particular agency may be undertaken in a case conference format.

  This form is used by employers to request a case conference with Comcare for multiple claims.

  
  

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• Rehabilitation assessment/examination (SRC116)
  
  

  This form is used to engage an approved workplace rehabilitation provider, medical practitioner or a panel of suitably qualified persons to assess an injured or ill employee's readiness and capacity to participate in a rehabilitation program.

  
  

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• Rehabilitation program (SRC40)
  
  

  This form is used to document the agreed rehabilitation program for an injured or ill employee. This includes, overall goal(s) (for example—to achieve an early, safe and durable return to work), consultation with key stakeholders, responsibilities for key stakeholders, actions and expected outcomes and, critical dates and costs.

  
  

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• Rehabilitation program alteration (SRC86)
  
  

  This form is used to document all changes to an agreed rehabilitation program once it has commenced in order to achieve the original agreed goals. These changes might include altered timeframes or additional costs or services.

  It may be necessary to alter a rehabilitation program more than once. A Rehabilitation program—alteration form should be used each time an alteration is made. However, if the overall goal(s) for a rehabilitation program change, the rehabilitation program should be closed using the Rehabilitation program cessation form.

  
  

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• Rehabilitation program closure record (SRC41)
  
  

  A cessation determination must be made when the delegate decides to close the rehabilitation program prior to its planed completion date and/or goal achievement. Where the rehabilitation program has been completed—i.e. the goals have been achieved and/or the end date reached—a formal determination is not required. However, page 2 of this form (the rehabilitation program closure record) must be completed and a copy sent to Comcare.

  
  

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• Suitable duties (SRC109)
  
  

  This form will assist the case manager and workplace rehabilitation provider (WRP) in working with the employee, their supervisor and treating doctor to identify suitable duties as soon as possible after an injury has occurred. Use this form as part of early intervention rehabilitation without waiting for the employee to lodge a claim for compensation.

  
  

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• Work trial agreement (SRC64)
  
  

  This agreement has been developed in consultation with the injured employee, medical practitioner, host employer, workplace rehabilitation provider and rehabilitation case manager. This agreement aims to secure a common understanding and commitment to the work trial and may be modified following consultation with all parties. This work trial agreement forms part of the agreed rehabilitation program and should be submitted to Comcare with the completed current rehabilitation program determination.

  
  

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• WRP Directory update form
  
  

  Comcare Approved Workplace Rehabilitation Provider (WRP) details are provided on the Comcare WRP Directory. This form is for WRPs to edit their contact details.

  
  

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