PG 205-09 SUPERVISION OF MEMBERS OF THE SERVICE RECEIVING PHYSICAL THERAPY FOR LINE OF DUTY INJURIES

Question 0

CLINIC SUPERVISOR

3. Provide the member with the following forms:
   a. CERTIFICATION OF LINE OF DUTY INJURY/AUTHORIZATION FOR TREATMENT (PD429-052) with attached Authorization for Release of Health Information Pursuant to HIPAA (OCA Official Form No. 960).
   b. THERAPY VERIFICATION (PD429-067).
   c. NOTIFICATION OF LINE OF DUTY THERAPY AUTHORIZATION (PD429-053).

MEMBER CONCERNED

4. Initial item 9b of Authorization for Release of Health Information Pursuant to HIPAA and sign form.
5. Present photocopies of CERTIFICATION OF LINE OF DUTY INJURY/AUTHORIZATION FOR TREATMENT and Authorization for Release of Health Information Pursuant to HIPAA to the integrity control officer along with THERAPY VERIFICATION and NOTIFICATION OF LINE OF DUTY THERAPY AUTHORIZATION.

Answer 0

INTEGRITY CONTROL OFFICER

Question 1

PURPOSE

To provide physical therapy treatments for members of the service injured in the line of duty.

PROCEDURE

When a district surgeon determines that a member of the service, injured in the line of duty requires physical therapy:

DISTRICT SURGEON WILL:

Answer 1

1. Prepare REQUEST FOR MEDICAL SERVICE AUTHORIZATION (PD429-164).
2. Direct member concerned to report to the clinic supervisor to obtain forms necessary to obtain treatment.

Question 2

INTEGRITY CONTROL OFFICER

Answer 2

6. Review forms and return THERAPY VERIFICATION to member.
7. Retain NOTIFICATION OF LINE OF DUTY THERAPY AUTHORIZATION and photocopies of CERTIFICATION OF LINE OF DUTY INJURY/AUTHORIZATION FOR TREATMENT and Authorization for Release of Health Information Pursuant to HIPAA for the duration of the member’s physical therapy treatment.

Question 3

MEMBER CONCERNED

8. Present to therapist, prior to treatment,

Answer 3

the CERTIFICATION OF LINE OF DUTY INJURY/AUTHORIZATION FOR TREATMENT with attached Authorization for Release of Health Information Pursuant to HIPAA.

9. Obtain schedule of treatments from therapy provider and forward to roll call personnel.

NOTE: Report any changes of therapy schedule to roll call personnel.

10. Update THERAPY VERIFICATION form to integrity control officer upon completion of final physical therapy session.

Question 4

INTEGRITY CONTROL OFFICER

11. Make periodic inquires to the therapy provider during the

Answer 4

course of treatments to ensure member is properly attending therapy.

NOTE: Physical therapy authorized by a district surgeon is never granted for a non line of duty injury. The fact that a member is on restricted duty does not entitle the member to attend physical therapy on duty.

Question 5

MEMBER CONCERNED

12. Return completed THERAPY VERIFICATION form to integrity control officer upon completion of final physical therapy treatment.

Answer 5

INTEGRITY CONTROL OFFICER

13. Verify member’s attendance for treatment at time and date specified on completed THERAPY VERIFICATION form.
14. Return copy of completed THERAPY VERIFICATION form to the Medical Bills Department of the Medical Division.

Question 6

ADDITIONAL DATA

When members attend physical therapy at the beginning of a tour, the member will report on duty upon arrival at therapy location, and be given a reasonable amount of time to travel back to command upon completion.

When members attend therapy in the middle of a tour of duty, the member will be given a reasonable amount of time to travel to the therapy location, complete the therapy, and be given a reasonable amount of travel back to command.

When members attend therapy near the end of a tour of duty. The member will be given a reasonable amount of time to travel to therapy location. Upon completion, the member will end the tour at the therapy location and will not be granted time to travel to his/her residence. If the therapy is completed prior to the scheduled end of tour, the member must request lost time by calling the command.

A member must submit a request for lost time if therapy commences after the start of tour and the member elects to travel from their residence to the therapy location direct. Alternatively, a member may request a tour adjustment and begin the tour upon arriving at therapy location, needs of the service permitting.

A change of tour should not be granted for the sole purpose of ensuring therapy occurs during department time, (i.e., an officer assigned to a midnight tour should not be granted a tour change to a day tour to attend an afternoon therapy session.)

District surgeons may authorize:

Answer 6

twelve (12) physical therapy sessions to a member of the service, and may repeat the authorization two (2) additional times for a total of thirty six (36) sessions. A member who requires additional therapy beyond thirty six (36) sessions must obtain authorization from a Department Orthopedist.

Question 7

RELATED PROCEDURES

Answer 7

Reporting Sick (P.G. 205-01)

Line Of Duty Injury Or Death Occurring Within City (P.G. 205-05)

Line Of Duty Injury Or Death Outside City In Residence Counties (P.G. 205-06)

FORMS AND REPORTS

REQUEST FOR MEDICAL SERVICE AUTHORIZATION (PD429-164)

CERTIFICATION OF LINE OF DUTY INJURY/AUTHORIZATION FOR TREATMENT (PD429-052)

THERAPY VERIFICATION (PD429-067)

NOTIFICATION OF LINE OF DUTY THERAPY AUTHORIZATION (PD429-053)

Authorization for Release of Health Information Pursuant to HIPAA (OCA Official Form No. 960)