25D - AGMT - EMPLOYEE INSURANCE - Laserfiche WebLink

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B) List of all appointments of employee kept and missed, together with reason, if any, for missing the appointment. C) Submission of the employee's anticipated treatment plan as a participant in the Program. This plan shall consist of the following: 1) The anticipated number of visits, appointments, or sessions requested of the employee, 2) The type of therapeutic procedures in general terms that the employee is to receive during the employee's participation with the REACH Program or the treatment provider(s). 3) Description of the treatment service provider the employee is referred to by REACH. 4) Any other information not contained in the employee's treatment service provider medical record deemed appropriate by the City to evaluate the employee's participation in the Assistance Program. D) Any conclusion or opinion of REACH or employee's treatment service provider that the employee is limited or restricted in his/her ability to perform the employee's job duties, such limitation may be, but not necessary, limited to physical, psychological, or medical reasons. E) Any conclusion or opinion of REACH or employee's treatment service provider that employee's participation may necessitate employee's absence from the City. F) That employee has failed, refhsed, or otherwise has discontinued to proceed with the REACH Program or any treatment service provider. G) Report consisting of the following: 1) Diagnosis 2) Summary of treatment or therapeutic procedures 3) Disabilities, limitations, or restrictions of employee 4) Recommendation on further treatment. The above information shall be considered confidential information not subject to disclosure by REACH unless the City employee has on file with REACH and any treatment service provider in the REACI-3 Program an irrevocable authorization(s), RELEASE OF INFORMATION to the City. On receipt of the City's request for the above information, REACH shall notify in writing, the City employee of the City's request. NOTE: The City agrees that in cases where an employee agrees to be referred by management to REACH, the Supervisor will seek written permission from the employee to inform REACH of the circumstances leading up to the referral. The City agrees to in no way insist or demand confidential information iron the REACH program on specific individuals who do not want their information released to tine City. 25D -18