Personal data
Here you enter the patient’s name and personal identity number or coordination number.
Field 1: The certificate is based on
Here you enter the grounds on which you have made the assessment. You can choose from several alternatives. The assessment should essentially be based on your own examination. If it is based on something else, state the reason.
Field 2a: The patient’s activities in the programme
Here you enter what the patient has explained that they are doing in their programme. You should make your medical assessment on the basis of the participant’s ability to perform their activities in the programme.
Examples of activities are study, work experience, jobseeker activities and employability rehabilitation.
Field 2 b: Extent of the programme (hours per week)
Here you enter what the patient states to be the extent of the programme.
Field 3: The patient has the following disability
Here you describe the disability that causes the reduced ability to participate in the programme, as observed by your and other professionals’ examination and through medical investigation. This could, for example, be reduced mobility, bending and stretching abilities, rotation, strength, concentration, memory function or energy.
Field 4: The patient has the following activity limitations
Describe tasks in relation to the programme activity that the patient cannot or should not perform because of the illness/injury. Here you assess and clearly describe how the illness limits the patient’s ability to perform the activity.
Activity limitations in the musculoskeletal system should be described so as to make clear what the patient cannot do: for example, if the patient has difficulty in moving around, cannot manage lifting or long-term static load on a particular part of the body.
With mental problems activity limitation may mean that the patient has major or minor difficulties with attention, learning new things, understanding instructions or beginning, performing or ending a task. The patient can also have difficulties in handling stress, changes and other psychological demands.
Field 5 a: The patient is prevented from participating in their activities because of illness/injury
Here you can state if it is your assessment that the patient is prevented from participating in their programme.
Field 5 b: The patient is prevented from participating in activities to the following extent and period because of illness/injury
Make your assessment based on the extent of the programme as described in field 2 b. If you do not know the extent, assume that the programme is full-time.
An example: Full-time corresponds to 40 hours per week. A 75 per cent programme thus corresponds to 30 hours per week. If the patient is 50 per cent prevented from participating in the programme, Arbetsförmedlingen considers that they are prevented from participating for 15 hours per week.
Field 6 a: In my opinion, the absence period, field 5b, can be shortened or reduced in extent with adaptation
Here you state whether the absence period, in your assessment, can be shortened or reduced in extent with adaptation. This is an important signal to Arbetsförmedlingen that the programme may need to be adapted so that the participant can take part despite their illness.
Adaptation means that the conditions in the programme are adapted on the basis of the programme participant’s limitations. This is to increase the participant’s opportunities to benefit from the programme.
Field 6 b: In my opinion, the following adaptations could shorten or reduce the extent of the absence period
Here you have the opportunity to suggest adaptations, or you can leave this field blank.
For example, an adaptation could be:
- the content of the activity,
- the place for the activity
- adapt the placement of the programme timing,
- work aids,
- personal assistance, such as guidance or personal support.
Field 7 a: After the absence period, field 5b, my assessment is that
Describe here your assessment of whether the patient can return to their activities in the programme, with or without adaptation, after the absence period. This is an important signal to
Arbetsförmedlingen that the programme may need to be adapted so that the participant can take part despite their illness.
Field 7 b: After the absence period, field 5b, my assessment is that
Here you have the opportunity to suggest adaptations, or you can leave this field blank.
For example, an adaptation could be:
- the content of the activity,
- the place for the activity
- adapt the placement of the programme timing, work aids,
- personal assistance, such as guidance or personal support.