Employee Medical Services Unit  

The Employee Medical Services Unit is responsible for monitoring the State Medical Director contract, as well as the contracts for testing for illegal use of drugs by State applicants and employees.  We also evaluate requests from employees under the State Employees Leave Bank Program.

Concentra

• Concentra Contact Information For State Medical Director's Office
• Concentra Forms
• Concentra Services and Related Costs Available under the State Medical Director (6-1-09)
• Concentra Sites and Network Sites
• Medical Records Release Form - (Revised 1/23/08)

Drug Testing Fillable Forms

• Form MS-DT2 - Drug Abuse Screen - Applicant Authorization - Revised 8/1/09 fillable form printable form
• Form MS-DT3 Employee Acknowledgement of Instruction in Testing - Revised 1/22/08 fillable form 
• Form MS-DT4 - Controlled Dangerous Substance Test Order - Revised 8/1/09 fillable form printable form
• HIPAA Form for Drug Testing - Revised 8/1/09 fillable form  printable form
• On-Site Drug Testing Request Form - Capitol MRO, Inc. (Issued January 2008) (fillable form)

Leave Bank Program

The State Employees' Leave Bank is not an entitlement, but an employee donation program that allows employees in the State Personnel Management System, as well as employees in independent personnel systems who elect to participate, to receive leave for a serious and prolonged medical condition. Employees who wish to join must donate at least 8 hours of unused annual, personal or sick leave (or a combination of the three) to become eligible members for two years. Donating employees who use sick leave to join the Bank must retain a sick leave balance of at least 240 hours after their donation.

Leave Bank Forms

• Fact Sheet for the State Employees' Leave Bank
• Leave Bank - Medical Leave Documentation
• Leave Bank HIPAA Form (printable read-only)
• MS401 Leave Bank Donation Form (printable, read-only)
• MS401 Leave Bank Donation Form (fillable form)
• MS402 Leave Bank Medical Request Form (printable, read-only)
• MS405 Leave Bank Employee to Employee Donation Form (printable, read-only)
• MS406 Leave Donation Appeal Form (printable, read-only)
• MS408 Leave Bank Request Form (printable, read-only)
• MS408 Leave Bank Request Form (fillable form)

Managed Return to Work Pilot Program (MRTW)

The Managed Return To Work Program is a pilot program for individuals with work related injuries or illnesses that result in temporary inability to fully perform normal work.  The Program provides these employees with meaningful and productive temporary transitional duty assignments. 

Managed Return to Work - Frequently Asked Questions