|U.S. Department of Labor||Office of Workers’ Compensation Programs
Division of Energy Employees Occupational
Washington, DC 20210
EEOICPA CIRCULAR NO. 17-03 DATE: March 3, 2017
SUBJECT: Nurse Consultant Referral Form
This Circular notifies Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff of the new Nurse Consultant Referral Form (Attachment 1). DEEOIC staff is to use the Nurse Consultant Referral Form when referring case-specific issues to Nurse Consultants to obtain medical advice and assistance.
When a DEEOIC staff person determines that a case would benefit from a nurse consultation, he or she is to complete the Nurse Consultant Referral Form and submit it, along with any attachments, to the email address listed on the form. The email address listed on the form is restricted to receive only DEEOIC employee emails. As is indicated on the form, it is critical that the staff person completing the form provide a detailed description of the specific service or assistance requested of the Nurse Consultant.
RACHEL P. LEITON
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Section