Qualified Rehabilitation Consultant Internship Completion Checklists (QRC) | Pdf Fpdf Doc Docx | Minnesota

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Qualified Rehabilitation Consultant Internship Completion Checklists (QRC) | Pdf Fpdf Doc Docx | Minnesota

Qualified Rehabilitation Consultant Internship Completion Checklists (QRC)

This is a Minnesota form that can be used for Workers Comp.

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443 Lafayette Road N. St. Paul, MN 55155 www.dli.mn.gov (651) 284-5005 1-800-342-5354 Qualified Rehabilitation Consultant (QRC) Internship Completion Checklists QRC intern: QRC intern supervisor: QRC intern #: QRC #: All required reports and progress records shall list the injured worker's name, WID number or SSN, and the date of injury. The QRC intern and QRC intern supervisor must sign all documents. 1. The orientation training packet provides R-forms, narrative reports, labor market analysis examples, and vocational testing and transferable skills analysis report examples. 2. Disability case management (DCM) services do not count towards completion of the internship. 3. Providing job placement and development services full time does not count towards completion of the internship. 4. Substantiated professional conduct complaints (for example, a stipulation or order for discipline) may affect the QRC intern's approval as a QRC. QRC internship basic requirements The QRC intern worked in "full-time employment," consistent with the employment experience requirement of the certifying body chosen by the intern. Where there is no definition of full-time employment by the certifying body, full-time employment means a minimum of 37 hours per week or more during a 52-week period (1,924 hours) or the same prorated part-time employment, providing rehabilitation services to injured workers. The QRC intern is the assigned QRC on all work examples submitted as evidence. The QRC intern is the job title on all documents (for example, reports, letters, email and business cards). The QRC intern obtained certification from the Commission on Rehabilitation Counselor Certification (CRCC) or Certification of Disability Management Specialists Commission (CDMS) and provided a copy of the certificate to the Department of Labor and Industry (DLI) within three years from the date of registration. The QRC intern renewal registration application(s) was completed and filed on a timely basis with DLI. The QRC intern appeared at administrative conferences and/or hearings with the QRC intern supervisor when requested or subpoenaed. The QRC intern attended the mandatory orientation training session within 12 months from the date of registration. The QRC intern attended the mandatory update training session, if scheduled by DLI. This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Required forms and reports The QRC intern supervisor's written report demonstrating the intern's competence to practice independently Rehabilitation Consultation Report (RCR) form with a narrative report explaining the basis for the eligibility determination · A restatement in the narrative report of the Yes/No questions of the RCR form is not sufficient explanation. R-2 Rehabilitation Plan form with an initial evaluation narrative report The eight required areas of the initial evaluation narrative report include: 5. relevant economic factors; 1. medical status; 6. transferable skills; 2. vocational history; 7. employment barriers; and 3. educational history; 8. recommendations 4. social history; Plan Progress Report (PPR) form or R-3 Rehabilitation Plan Amendment form with PPR items 20 through 23 completed, with the corresponding narrative report that specifically includes: 1. the identified barriers to the employee's successful completion of the rehabilitation plan; and 2. the measures the QRC intern took to overcome each of the identified barriers R-8 Notice of Rehabilitation Plan Closure form with a narrative summary report attached · The narrative summary report must include all rehabilitation plan services provided (not a monthly progress report) on behalf of the injured worker. A narrative report showing the QRC intern's understanding of vocational testing A narrative report showing the QRC intern's understanding of a transferable skills analysis (TSA) Labor market analysis (LMA) showing the QRC intern's understanding of the injured worker's qualifications, work restrictions and labor market conditions when establishing vocational goals or recommendations The QRC intern and QRC supervisor's signatures on all QRC intern documents This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2

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