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The Allied Health Professions Advisory Fitness for Work Report and how to complete it

Allied Health Professional (AHP) Health and Work Report

4.1 Back pain example: Completed report

See this example of how the AHP Report has been completed

Allied Health Professions
Advisory Fitness for Work Report

1 Patient's name: Fiona Hardwick
Date of birth: 19/07/1972

I advise that:

1a you are not fit for work.
1b you may be fit for work taking account of advice below

2 This form has been completed by a:
Physiotherapist / Occupational Therapist / Podiatrist / Other

Practitioner's name: Your Name
HCPC registration number: OT XXXXX
Organisation/Service: Name of your service / department / unit
Contact details (email/ tel no.):
Date assessment completed: 19/07/2019
4 AHP Advisory Fitness for Work Report issued for period from 19/07/2019 to 20/08/2019
A follow up review is / is not required* has been made for 20/08/2019 *delete as appropriate

5 With your employer's agreement you may benefit from these or more options:

a phased return to work
amended duties
altered hours
a workplace assessment

6 Patient-reported work-relevant difficulty, recommendations and goals:

Difficulty Recommendations / goals
Difficulty managing daily activities due to low back pain. To attend a six week back pain rehabilitation programme, Weds 1.30 - 4.00 starting 14/08/2019
Back pain worse in mornings (currently working reduced hours 11.00-16.00 Mon-Fri) Gradually increase to usual hours by September e.g.
wk/beg 29/07/19 10.30 - 16.00
wk/beg 05/08/18 10.00 - 16.00

(to incorporate rehabilitation programme)
Back pain worse by sitting in low chairs and for more than 20 minutes e.g. attending meetings, driving pool cars. Does not need to avoid these activities. To gradually increase as comfort allows e.g. initially sitting for 10 minutes in pool care. Encourage to take changes of position/breaks in meetings.
Lacks confidence in going on site as concerned that some movements e.g. bending, squatting, standing, might increase her back pain. To 'buddy up' with colleagues on site visits while regaining confidence in usual work activities.

7 Comments

Reassured that no further investigations required. Does not need to avoid any activities, although some may be uncomfortable and increase pain if she does too much too soon. We hope she will have returned to full hours and duties by the end of October if not before. She may have occasional flare-ups of back pain in future but should be able to remain at work with temporary minor adjustments.

8 Additional information is provided on 0 accompanying sheets
9 Signature: Your signature

AHPs: please follow the guidance held on the website of your professional body when filling out this form and always attach the information sheet for employees, employers and doctors. Employees, employers and doctors: please read information attached or log on to: www.ahpf.org.uk

This report does not replace the Statement of Fitness for Work (fit note) for benefits purposes.

 
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