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State Management Personnel Manual

2600 Employee Health Service

2620(A) Agency Referral Examinations


.110 General Information

.111 Examinations are conducted for employees referred by State agencies for a variety of reasons including excessive use of sick leave credits; medical evaluation of employees on extended sick leave; and employees whose work performance may be adversely affected by what appears to be a health or mental condition, alcoholism, or drug abuse. In this situation, EHS provides the referring agency with a determination regarding the employee's capability to perform the essential functions of a job title or assigned duties. The agency may use this determination to make administrative decisions about personnel actions concerning the employee.

NOTE: When an agency places an employee on involuntary leave because of a mental or physical disability pursuant to Section 72 of the Civil Service Law, due process requirements described in that statute must be followed. Medical evaluations may only be performed by a physician selected by the Civil Service Commission. Questions on these matters should be referred to the Office of the Counsel, Department of Civil Service. Additional information concerning Section 72 procedures can be found in SPMM Section 2234 and Policy Bulletin No. 84-03. Information concerning Section 71 and Rule 5.9 can be found in SPMM Section 2200 and Policy Bulletin No. 90-02.

.112 Location—Agency referral examinations are conducted at the EHS medical examination center in Cohoes and at the offices of EHS consulting physicians in the following cities: Binghamton, Buffalo, Elmira, New York City, Plattsburgh, Poughkeepsie, Rochester, Stony Brook, Syracuse, Utica, Watertown, and White Plains. Agencies choosing to have evaluations conducted at locations other than the Cohoes medical examination center or by consultants who are not employees of the Department of Civil Service, must pay the provider's fee.

.113 Referrals must be made in writing to the EHS Medical Director in Cohoes. EHS personnel do not provide employees with copies of agency referral letters unless the client has requested a copy of the medical record in writing. In those instances where employees claim to be unaware of the reason for the medical evaluation, it may be necessary for the evaluating physician to confront the employee with examples of the behaviors or work-related problems that led to the agency's medical examination request. To accomplish this, the examining physician may paraphrase referral letter information.

.114 EHS may not withhold information in a medical or nursing record about an individual just because it came from the individual’s employing agency. If the source furnished the information under a promise of confidentiality, EHS has a responsibility to protect the identity of that source individual. EHS should remove or redact any references to specific names or other information that could expose the source of the information. Only the identity of individuals is protected, not the information they furnished. Agencies should be advised that any information supplied to EHS is subject to access by the employee as part of his/her medical or nursing record. The agency must notify EHS of any need to keep sources confidential.


.410 Arrangements

.411 A request for an agency referral examination should be made on an EHS-707, Agency Request for Medical Examination and mailed to EHS by the appropriate agency personnel officer. Facsimiles may be sent to (518) 233-3131. The agency must include a written narrative outlining the reasons for the evaluation (including all information listed below that is not included on the EHS-707). The extent and precision of the EHS medical report and recommendation in any particular referral depend greatly on the completeness of information provided by the agency prior to examination. All material should be addressed to EHS and marked "confidential." The request should provide as much of the following information as possible:

  • Full name of employee
  • Social security number
  • Date of birth
  • Number of years employed
  • Address
  • Title
  • Employee’s agency
  • Business phone number
  • Citation of the Section of Law, Rule, Regulation or Collective Bargaining Agreement authorizing the medical evaluation
  • Work and pay status at time of referral
  • Reason for referral including a description of the problematic on-the-job behavior
  • Pertinent work history
  • Formal job description, as well as a description of the employee's actual job assignment and tasks which may be listed in the employee's performance program
  • Medical reports from the treating physician or State Insurance Fund
  • Statement as to whether the agency contemplates or is willing to accept job task assignment restrictions or to provide reasonable accommodations
  • Statement as to whether the agency plans or is willing to modify the employee's job assignment upon return to work
  • Name, signature, title, address, phone number, and fax number of the person requesting the examination
  • Name and phone number of the agency's contact person responsible for scheduling the evaluation
  • Date EHS-707 completed
  • Name, address and phone number of the individual approving payment of consulting physician and other fees associated with the evaluation
  • The employee's agency code
  • Cost center code if the agency wishes this information to appear on the consulting physician's billing statement
  • The preferred service location

.412 If the required information (including the legal basis for the exam, a written narrative, and medical information) is not received by EHS with the EHS-707, the examination will not be scheduled. The agency will be contacted to obtain the required information.

.420 Notification

.421 EHS will notify the agency personnel office by telephone or e-mail of the date, time and place of the employee's appointment which will be scheduled after an EHS physician reviews the information submitted by the agency. This review determines the type of examination required to make an accurate determination of the employee's fitness and to provide the agency with an estimated cost, if any, of the medical evaluation.

.422 The agency personnel office is responsible for notifying the employee of the appointment and notifying EHS of any cancellation or needed change in the appointment. Agencies may be charged a cancellation fee if employees fail to keep appointments with contract or consultant medical evaluators. Agencies will be charged the full cost of visits if employees fail to appear for their appointments with our psychiatrists/psychologists.

.423 Following the examination, EHS will notify the agency concerning the results of its evaluation of the employee's fitness to perform the essential duties of his/her position. This notification is usually made by letter and mailed to the person requesting the exam. This letter can be faxed, at the agency’s request.

TM-63; July, 2008

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