Return Appendix 
Limitations at Work 
To whom it may concern: 
As a physician who cares for patients, I have either made recommendations for normal work activity or negotiated limitations with the patient. My limitations are in accordance with the AHCPR Guideline #14 Low Back Problems modifications of lifting guides and always include recommended alternative activity to reduce the debilitation of being away from normal duty warning that there may well be a need to build activity tolerance through conditioning if not returning to normal Activity ASAP (see back of signed limitations sheet). 
First, I agree it is reasonable for this patient to carry out the job if sitting or unaided lifting demands no greater than what I have negotiated on my limitations sheet (an employer must judge the individual's ability to carry out specific tasks relative to the safety of the patient and others).  Many factors including aches and pain can affect safe accurate task performance.) 
Second, I agree that It is reasonable for this patient to be given the opportunity to carry out the job if sitting and unaided lifting demands are modified to within recommendations on my limitations sheet according to the recommended limitation at this point in time. 
Third, I do not agree that my patient, in all likelihood, will reasonably tolerate the job with sitting or unaided lifting demands greater than those on my limitations sheet.  Though it will probably not do any true bodily damage, it may increases discomfort and foster more nonphysical issues to slow progress or lengthening recuperation time. 
The only recommendations I can make medically are on the limitation sheet.  Please see the most recent limitation sheet that I have signed and feel free to discuss it with the patient as employer or supervisor as necessary. 
I hope my recommendations and reasons and those of the AHCPR Guideline #14 are clear.  My patient and your client surely appreciate your work, consideration, understanding and expertise in these matters. 
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