Hawaii Administrative Rules
Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
Chapter 14 - REHABILITATION
Subchapter 6 - ENROLLMENT IN REHABILITATION PROGRAMS
Section 12-14-35 - Enrollment requirement
Universal Citation: HI Admin Rules 12-14-35
Current through August, 2024
Pursuant to section 386-25(c), HRS, a provider shall use a form approved by the director to enroll an employee into a program.
(1) An approved enrollment form shall include:
(A) Employee
information - name, address, telephone number, and social security
number;
(B) Employer information -
name, address, telephone number and department of labor account number, as
assigned by the department's unemployment insurance division;
(C) Insurer information - name, address, and
telephone number;
(D) Provider
information - name, address, specialist's name, and telephone number;
and
(E) Statement of worker's
rights and responsibilities developed by the director and reproduced by the
provider, shall be reviewed with the employee by the specialist, and signed and
dated by both. The signatures shall be documentation that the specialist and
the employee understand this document and its implications and both are
committed to a realistic rehabilitation process, the goal of which is suitable
gainful employment for the employee.
(2) A copy of the completed enrollment form and statement of worker's rights and responsibilities shall be sent together with the initial evaluation to the employee, the director, and the employer.
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