Written Medical Opinion For Employer (Page 6 of 8) in pdf

Federal Register/

l. 81

No. 58/

Friday,

March

25,

2016/Rules and

Regulations

16885

employee

reports a history of abnormal

kidney function tests, the PLHCP may want

to order a baseline renal function tests (e.g.,

serum creatinine and urinalysis). As

indicated above, the PLHCP may order

annual TB testing for silica-exposed

employees

who are at high risk of developing

active TB infections. Additional tests that

PLHCPs may order based on findings of

medical examinations include, but is not

limited to, chest computerized tomography

(CT) scan for lung cancer or COPD, testing for

immunologic diseases, and cardiac testing for

pulmonary-related heart disease,

such as

car

pulmonale.

3. Roles and Responsibilities

3.1.

PLHCP. The PLHCP designation refers

to "an individual whose legally permitted

scope of practice

(i.e.,

license, registration, or

certification) allows him or her to

independently provide or be delegated the

responsibility to provide some or all of the

particular health care services required" by

the respirable crystalline silica standard. The

legally permitted scope of practice for the

PLHCP is determined by each State. PLHCPs

who perform clinical services for a silica

medical surveillance program should have a

thorough knowledge ofrespirable crystalline

silica-related diseases and symptoms.

Suspected cases of silicosis, advanced COPD,

or other respiratory conditions causing

impairment should be promptly referred to a

Board Certified Specialist in Pulmonary

Disease or Occupational Medicine.

Once the medical surveillance examination

is completed, the employer must ensure that

the PLHCP explains to the employee the

results of the medical examination and

provides the employee with a written

medical report within 30 days of the

examination.

The written medical report

must

contain

a statement indicating the

results of the medical examination, including

any medical condition(s) that would place

the employee at increased risk of material

impairment to health from exposure to

respirable crystalline silica and any medical

conditions that require further

evaluation

treatment. In addition, the PLHCP's written

medical report must include any

recommended limitations on the employee's

use of respirators, any recommended

limitations on the employee's exposure to

respirable crystalline silica, and a statement

that the

employee

should be examined by a

Board Certified Specialist in Pulmonary

Disease or Occupational medicine if the chest

X-ray is classified as 1/0 or higher by the B

Reader, or if referral to a Specialist is

otherwise deemed appropriate by the PLHCP.

The PLHCP should discuss all findings and

test results and any recommendations

regarding the employee's health, worksite

safety and health practices, and medical

referrals for further evaluation, if indicated.

In addition, it is suggested that the PLHCP

offer to provide the employee with a

complete copy of their examination and test

results, as some employees may want this

information for their own records or to

provide to their personal physician or a

future PLHCP. Employees are entitled to

access their medical records.

Under the respirable crystalline

silica

standard, the employer must ensure that the

PLHCP provides the employer with a written

medical opinion within

days of the

employee examination, and that the

employee also gets a

copy

of the written

medical opinion for the employer within 30

days. The PLHCP may choose to directly

provide the employee a copy of the written

medical opinion. This can be particularly

helpful to employees, such as construction

employees, who may

change

employers

frequently. The written medical opinion can

be used by the employee

proofof up-to-

date medical surveillance. The following lists

the elements of the written medical report for

the employee and written medical opinion

for the employer. (Sample forms for the

written medical report for the employee, the

written medical opinion for the employer,

and the written authorization are provided in

Section

of this Appendix.]

3.1.1. The written medical report for the

employee must include the following

information:

3.1.1.1. A statement indicating the results

of the medical examination, including any

medical condition(s] that would place the

employee at increased risk of material

impairment to health from exposure to

respirable crystalline

silica

and any medical

conditions that require further evaluation or

treatment;

3.1.1.2. Any recommended limitations

upon the employee's use of a respirator;

3.1.1.3. Any recommended limitations on

the employee's exposure to respirable

crystalline silica; and

3.1.1.4. A statement that the employee

should be examined by

Board Certified

Specialist in Pulmonary Disease or

Occupational Medicine, where the standard

requires or where the PLHCP has determined

such a referral is necessary. The standard

requires referral to

Board Certified

Specialist in Pulmonary Disease or

Occupational Medicine for a chest X-ray B

reading indicating small opacities in a

profusion of 1/0 or higher, or if the PHLCP

determines that referral to a Specialist is

necessary for other

silica-related

findings.

3.1.2. The PLHCP's written medical

opinion for the employer must include only

the following information:

3.1.2.1. The date of the examination;

3.1.2.2. A statement that the examination

has met the requirements of this section; and

3.1.2.3. Any recommended limitations on

the employee's use of respirators.

3.1.2.4. If the employee provides the

PLHCP with written authorization, the

written opinion for the employer shall also

contain either or both of the following:

(1)

Any recommended limitations on the

employee's exposure to respirable crystalline

silica; and

(2)

A statement that the employee should

be examined by a Board Certified Specialist

in Pulmonary Disease or Occupational

Medicine if the chest X-ray provided in

accordance with this section is classified as

1/0 or higher by the B Reader, or if referral

to a Specialist is otherwise deemed

appropriate.

3.1.2.5. In addition to the above referral for

abnormal chest X-ray, the PLHCP may refer

an employee to a Board Certified Specialist

in Pulmonary Disease or Occupational

Medicine for other findings of concern

during the medical surveillance examination

if these findings are potentially related to

silica exposure.

3.1.2.6. Although the respirable crystalline

silica standard requires the employer to

ensure that the PLHCP explains the results of

the medical examination to the employee, the

standard does not mandate how this should

be done. The written medical opinion for the

employer

could

contain a statement that the

PLHCP has

explained

the results of the

medical examination to the employee.

3.2.

Medical

Specialists.

The silica

standard requires that all employees with

chest X-ray B readings of 1/0 or higher be

referred to a Board Certified Specialist in

Pulmonary Disease or Occupational

Medicine. If the employee has given written

authorization for the employer to be

informed, then the employer shall make

available a medical examination by a

Specialist within 30 days after receiving the

PLHCP's written medical opinion.

3.2.1. The

employer

must provide the

following information to the Board Certified

Specialist in Pulmonary Disease or

Occupational Medicine:

3.2.1 .1. A description of the employee's

former,

current,

and anticipated duties as

they relate to the employee's occupational

exposure

to respirable crystalline silica;

3.2.1 .2. The employee's former, current,

and anticipated levels of occupational

exposure to respirable crystalline silica;

3.2.1.3. A description of any personal

protective

equipment

used or to be used by

the employee, including when and for how

long the employee has used or will use that

equipment; and

3.2.1.4. Information from records of

employment-related medical examinations

previously provided to the employee and

currently within the control of the employer.

3.2.2.

The

PLHCP should make certain

that, with written authorization from the

employee, the Board Certified Specialist in

Pulmonary Disease or Occupational

Medicine has any other pertinent medical

and occupational information necessary for

the specialist's evaluation of the employee's

condition.

3.2.3.

Once the Board Certified Specialist

in Pulmonary Disease or Occupational

Medicine has evaluated the employee, the

employer must

ensure

that the Specialist

explains to the employee the results of the

medical examination and provides the

employee with a written medical report

within 30 days of the examination. The

employer must also ensure that the Specialist

provides the employer with a written

medical opinion within 30 days of the

employee examination. (Sample forms for the

written medical report for the employee, the

written medical opinion for the employer

and the written authorization are provided in

Section 7 of this Appendix.)

3.2.4. The Specialist's written medical

report for the

employee

must include the

following information:

3.2.4.1. A statement indicating the results

of the medical examination, including any

medical

condition(s)

that would place the

employee at increased risk of material

impairment to health from exposure to

Written Medical Opinion For Employer Page 6

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