Using the FEM - First Medical Report form for an IOD



In case of an on-duty accident, injury, or occupational disease, employees seeking compensation for medical treatment should complete the FEM - First Medical Report. This report should include incident details and be accompanied by all supporting documents. The Practitioner should also specify if further medical tests or consultations are needed, as well as the Patient's fitness to return to work. Submit these documents to The Federated Employers Mutual Assurance Company.

Please Note: In order for the Practice to use the FEM - First Medical Report form and for the Patient data to properly populate on the form, the Debtor needs to be loaded as an IOD Debtor. For more information on how to create an IOD Debtor, please refer to the user manual: Create New IOD Debtor.

  • The contents of this User Manual will consist of the following information:
    • Employee Details.
    • Accident Details.
  • This user manual will start on the Diary screen.



  • Click on the desired booking to access the Sidebar.


  • The Diary sidebar will open.


  • Click on the Clinical button to access the Clinical Case screen.

  • The Clinical Case screen will open.


  • Click on the Forms Library drop-down menu on the Sidebar.


  • Select the form named FEM - First Medical Report.

  • The form will be added to the Sidebar under the Active Forms section. 


  • The FEM - First Medical Report form will open.


Please Note: When an individual sustains an injury while at their workplace or while performing work-related tasks off-site and requires medical treatment, it is essential to have the employer's information in order to file a claim with the Workers' Compensation Fund.
Employee Details

The personal details of the Patient that is being treated.   

  • The following information will appear in the Employee section: This is all the personal employee information relating to the Patient that has been assessed by the Practitioner.
    • The information for these fields is filled in automatically as the information is pulled through from the Debtor's file.


    • Claim Number: The Claim number that has been received from The Federated Employers Mutual Assurance Company. This is the number that will be used to submit the claim. 
    • Employer: The Patient's Employer, for whom they are working. 
    • Employee: The Name, Surname and Initials of the injured Patient. 
    • Staff Number: The number that has been allocated to the Patient by their Employer.
    • Date of Accident: The Date that the incident took place.


Accident Details 

The Accident Details will contain all the information from the initial (first) medical evaluation in order for the Accident to be documented and to determine what transpired.

  • Complete or Select the relevant option for each field:


    • 1.a Time and place of first attendance by you: The Date, Time and Place where the Patient first consulted with the Practitioner regarding the incident.
      • Date: The Date the Patient was seen by the Practitioner, this particular date will also be the date the booking was made. The Date can be entered manually or be selected from a Date Picker.
      • Time: The Time when the Patient was consulted by the Practitioner. 
        • Click on the Clock in the Time field to open the time selector, or type in the time.





    • b. Has employee previously attended (more than once) for his accident by any other registered medical practitioner\(other than your partner or assistant)?*: Complete the relevant information required in the Text field.




    • 2. How did the alleged accident happen?: Complete the information in the Text box/field to indicate how the accident happened.




    • 3. Full clinical description of injury(ies)(precision is essential and the technical terms may be used) Please add additional pages if necessary: Complete the information of the Patient's injuries in the Text box/field.




    • 4. In your opinion, is the employee's condition due to the accident described in item 2 above?: Complete the Text box with a Yes/No answer.




    • 5. (Describe briefly any pre-existing defect or disease evident at the time of examination): Complete the relevant information in the Text box/field.





    • 6. X-RAY EXAMINATIONS: If the Patient has been sent for an X-Ray examination, then the details need to be completed with the relevant information. 
      • Date: Complete the Date of which the Patient need to go for an X-Ray examination.
      • By whom made: Complete the name of the Radiologist or Radiology Practice that will perform the examination.

    • 7. SURGICAL OPERATIONS (Including setting of fractures and reduction of dislocations): If the Patient has undergone any previous Surgical Operations or has any fractures set or dislocations reduced.
      • Date: Select the Date from the Date selector or Type in the Date in the Date field.
      • Brief note: A Brief Note can be filled in the Text box/field in regard to the Patient's previous Surgical Operations.

      • ANAESTHETICS: Anaesthetics are used on a Patient if they need to be put under sedation for the Procedure. 
        • Local or general anaesthetics used? Complete the question in the Text box/field with a Yes/No answer.
        • By whom: Fill in the Anaesthesiologist's name of who administered the anaesthesia.
        • If general please state duration in (minutes): Fill in the amount of minutes general anaesthesia was administered to the Patient.



    • 8.a Have you referred the patient to another medical practitioner?: Select the correct answer Yes/No from the drop-down menu to indicate if the Patient has been referred to another Practitioner for more or alternative Medical assistance. 
      • If YES, to whom: Fill in the Practitioners details to whom the Patient has been referred to in the Text box/field.
      • Date: Select the Date from the calender to indicate the Date the Patient was referred.



      • b Have you ordered physiotherapy?: If a Patient needs to be referred to a Physiotherapist, the Practitioner will complete the below section:
        • If so, with whom?: Complete the referred Physiotherapist's details for whom the Patient is being referred. 
        • Date: Select the correct Date from the Date Picker to indicate the Date that the Practitioner ordered Physiotherapy.



.

  • 9.a Is this employee unfit for work?: Select the correct Yes/No answer from the drop-down menu, to indicate if the Patient is unfit for work.



    • b. On what date, in your opinion is he/she likely to be fit for: The Practitioner needs to advise if the Patient can return to Light Duty or Normal Duty.
      • Light Duty: Type in the Date to indicate when the Patient is fit to return to perform Light Duty work.
      • Normal Duty: Type in the Date to indicate when the Patient is fit to return to their Normal Duty.



    • 10. Any further remarks: Fill in any additional information in the Text box/field regarding the Patient.




    • Doctor Signature: After all the information on the form has been completed, the Practitioner must sign the form in order to validate all information.



    • Date: Select the Date the form has been completed.

    • Click on the Complete button, to indicate that the form is completed with the necessary information. 


      • The Complete button will turn green indicating that the form is ready to be saved.


        • The form will also be indicated as Completed at the top of the panel.


    • Click on the Save and Close button to save all the changes made.

Last modified: Wednesday, 10 January 2024, 9:56 AM