🔗 Linked Evidence
BCRTC_MEDICAL_QUESTIONARE — p.2
📄 BCRTC MEDICAL QUESTIONARE | p.2
📄 BCRTC MEDICAL QUESTIONARE | p.2
📝 Extracted Text (OCR)
bertc MEDICAL QUESTIONNAIRE Date: April 2, 2026 RE: MARK HOLAND Dear Dr. Ademiluyi, Thank you for the completion of an Occupational Fitness Assessment on March 26, 2026 regarding Mark Holand to assist with return to work planning. Within the Occupational Fitness Assessment, physical and psychological limitations to return to work were identified as follows: - Lifting limited to <20lbs - Walking limited to <30mins - Agitation, anxiety, insomnia and poor concentration - Communication with colleagues moderate to severely restricted We require additional information from you regarding the restrictions and limitations mentioned. In circumstances where an individual is unable to perform the core duties of their position due to a temporary or permanent disability, BCRTC parties will meet to discuss and consider the available medical evidence regarding the nature of the disability and, if necessary, options with respect to the accommodation of the employee. BCRTC will safeguard all medical information received about them in accordance with applicable privacy legislation. Helpful terminology used in Occupational Medicine to guide fitness to work: Impairment: A significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder or disease. Limitation: A limitation is an activity that a person would be physically or mentally incapable of performing even if they wanted to perform it because of an impairment. Restriction: A restriction is an activity that you would not allow a patient to perform, even if that patient were capable of performing it, because of an unacceptable risk resulting from that patient’s impairment. Please find included the completed Authorization form allowing disclosure of this information to BCRTC Occupational Health. Instructions Physician/Health Care Provider: 1. Ensure your patient has completed Employee Consent below. 2. Complete Occupational Fitness Assessment (OFA) Form. 3. Please return the completed OFA form via fax to 604-520-5552 or via email to adebayo_adenekan@bertc.bc.ca Billing Instructions Please fax your invoice in accordance with BCMA fee schedule for completion of the attached form to 604-520- 5552. Please note that we are unable to process an invoice unless it contains your invoice number and MSP billing number. Should you require pre-payment, the fee is paid by the employee and then a receipt may be Page 2 of