Professional Disclosure Form Letter to Providers

July 28, 2006


TO: All Agency Approved Vocational Rehabilitation Providers

FROM: David R. Campbell

RE: Disclosure Form Usage

As some of you may know, I convened an Advisory Team a few months ago to enable the Agency to maintain contact with current and future trends in the field of vocational rehabilitation as it relates to workers' compensation, and to provide a forum for discussion of new ideas and process improvements. This cross-functional group, which is made up of some of your peers as well as individuals from various perspectives in the workers' comp arena, meets on a quarterly basis to address old and new business. Some of the old business includes revisiting the recommendations from the Task Force on Vocational Rehabilitation, which concluded in the year 2000. Doug Langham oversaw that team, and one of their resulting recommendations was in fact that an ongoing advisory group be established. This same group also recommended broad additions and updates to the Administrative Rules regarding vocational rehabilitation, a task that the current advisory team is working on.  Within these recommended rule changes is a requirement that, "Each injured worker served by an approved rehabilitation provider shall be provided a copy of the Vocational Rehabilitation Provider Professional Disclosure Form." At the time of the drafting of this requirement, no such form existed.  However, due to the excellent work of the current Advisory Team, a disclosure form has been created for your use.


Beginning today, use of the attached AGENCY APPROVED VOCATIONAL REHABILITATION PROVIDER PROFESSIONAL DISCLOSURE FORM is a requirement for all approved facilities. The form should be used at the start of every new vocational counseling case for which comprehensive services will be provided. If your client is not supportive of signing the document, please note this on the form and sign in your designated location. It is important to remember that this type of disclosure is not a new procedure, but one that all counselors should be doing as part of their normal practices. It is consistent with the recommendations of the 2000 VR Task Force, the 2006 Advisory Team, the CRC Code of Professional Ethics, and the CDMS Code of Professional Conduct. In reality it serves as protection for you and your client during the counseling relationship, and is just good practice.


Thank you for your attention to this new procedure. The disclosure will be available online also at As always, please don't hesitate to call or write with questions or concerns.