It’s not often that an employee’s doctor’s note goes viral and winds up on the Internet. The website Buzzfeed, however, got a hold of a pic showing a humorously lame attempt at a “fake” doctor’s note, and posted it for all to see. The note, due to its glaring spelling, grammar, and formatting errors, was not only rejected by the employer, but marked up in red marker with the abandon of an English professor with a grudge. The employer even scrawled the words, “How NOT to fake a doctor’s note” across the bottom, a humorous yet stern rebuke of the folly of such a half-hearted attempt to play hooky.

Shoddy efforts to ditch work notwithstanding, many people legitimately request doctor’s notes when they’re too sick or injured to perform their job duties. And as urgent care centers have become a viable and recognized alternative to the doctor’s office, they face many of the same questions surrounding doctor’s notes:

When is it okay to issue them? How much leave time should they sign off for? What details about the employee’s visit are they allowed to disclose to an employer who later requests verification? And how do they handle worker’s compensation cases?

Here are a few areas of consideration for urgent care relating to doctor’s notes.

Policy

An urgent care center should have a policy in place for handling the issuance of doctor’s notes. Though not primary care providers, many centers will indeed issue doctor’s notes upon request. However, it’s not a cut-and-dried issue. “Work excuse requests often put the urgent care provider in an ethical conundrum not easily reconciled,” says Lee A. Resnick, M.D., FAAFP, and President of the Institute of Urgent Care Medicine. “Am I to doubt my patient who says they can’t work due to illness or somehow question the “degree” of illness or their experience of it? Most urgent care providers will believe the patient, and rightfully so, as we’re not the illness police.”

Urgent care centers can use pre-printed pads on safety paper for work excuse notes, but they should be guarded closely, like Rx pads. Or doctor’s notes can be written on letterhead or stationary that’s professional-looking and high-quality.

The amount of work time given off can vary. Whether it’s just for the visit, the remainder of the day, or multiple days thereafter, it should be at discretion of the provider. Keep in mind that urgent care generally handles minor injury and illness, so a patient with an acute or chronic condition requiring extended convalesce should be directed to a primary care provider or specialist.

Verification

Even for doctor’s notes that carry the appropriate level of authenticity (unlike the earlier case), some employers may choose to follow up with the urgent care provider. In such cases, there are limits to the information a provider can divulge. “If a patient has not given pre-authorization, the urgent can’t provide additional details,” says K Royal, a Scottsdale, Arizona-based health care attorney who specializes in issues of patient privacy and regulatory compliance. “Also, if the employer or school merely wants to confirm the validity of a written release or time off, the clinic can confirm authenticity of the document, but only if they can see it, such as a faxed copy or scanned email attachment.”

Worker’s Comp

When managing worker’s comp cases, employers expect thorough vetting from the urgent care provider they’ve contracted with. This comes in the form of solid documentation of injuries, location, causes, and other pertinent factors that provide the clearest possible picture of the injury claim. Additionally, employers favor “work hardening” recommendations when applicable, rather than straight time off. This not only paves the way for the employee to return to productive work functions more quickly, but it improves clinical outcomes. Not to mention the reduction in lost wages and lower workers comp insurance premiums that result from on-job rehabilitation programs.

Back-dating

Should a provider ‘back-date” a doctor’s note, excusing work days missed that occurred prior to the patient presenting in the urgent care? This one can be tricky. When implemented, it will depend on the provider’s assessment of how long, in their professional opinion, the condition left the employee unable to perform their normal duties. It’s a judgement call at best, and it’s not one without risk. The urgent care could a gain a reputation for a place to go for an excuse off work, leaving it to decide if that reputation is one it wants to have.

In sum, it’s key to have a well-documented and thorough doctor’s note policy in place, and adhere to it strictly to prevent employee misunderstandings and patient abuses. The good news is, when implemented earnestly, issuing doctor’s notes can cast an urgent care in a favorable light among patients, positioning it as a ready stand-in for the doctor’s office when illness or injury leaves them unable to work.

The original “doctor’s note” in question can be seen here.