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The new workers’ comp guidelines from the state of Washington’s Department of Labor and Industries offer specific examples to help providers communicate effectively with claims managers. Here is an example offered to describe assessments of psychiatric treatment and recommendations:
Example. Diagnosis: Depression. Major. Single episode (296.2)
1. Physical Activity
• Goal: Within 60 days patient will have returned to his pre-injury level of activity.
• Measurement: Patient will log hours of sleep and daily activities.
• Interval: Patient will complete log daily; logs will be reviewed weekly.
• Mileposts: Week 1 — Patient will sleep no more than 10 hours a day by the end of the week, and will document 20 minutes of activity, daily, by the end of the week. Week 2: Patient will sleep no more than nine hours a day by the end of the week, and will have increased daily exercise to 30 minutes per day. Weeks 3 through 8: Sleep will not exceed eight hours per day; patient will exercise at least one hour daily.
• Goal: Decrease or eliminate anger-related return-to-work barriers.
• Measurement: Patient response to scenarios that currently cause patient to become angry and poorly communicative.
• Interval: Will be assessed at each counseling session.
• Mileposts: By week 4, patient will be able to verbalize the reasons for his anger. By week 8, patient will be able to remain appropriately communicative in employment situations that currently evoke angry outbursts.
3. Return to Work
• Goal: Within 90 days, patient will return to work full time.
• Measurement: Patient completes gradual return-to-work plan.
• Interval: Patient’s progress will be assessed monthly.
• Mileposts: Month 1 — By the end of the first month of treatment, patient will have returned to work part time 4 hours a day with restricted duties. Month 2 — By the end of the second month of treatment, patient will have returned to work part time six hours a day and assumed normal duties. Month 3 — By the end of the third month of treatment, patient will have returned to work full time.