● All new cases for evaluation. ● Continuing symptoms if current treatment is not effective in pro- viding relief. Follow-up Actions ● Review medical regimen and compliance with medical recom- mendations. ● Assess major job functions and ability to complete tasks and eval- uate the need for special job ac- commodations. ● Discuss proper nutrition, having the employee maintain a nutrition diary for a period of time and consider the need for a referral to a nutritionist. ● Provide information on the bene- fits of exercise options including aquatic therapy, light physical ac- tivity, stretching, tai chi, therapeu- tic touch, and yoga. Advise the employee to discuss the options with personal health care provider. ● Discuss sleeping patterns and sug- gestions to promote restful sleep. Refer to ear, nose, throat (ENT) or sleep clinic if signs and symptoms of sleep apnea such as snoring, la- bored breathing, apnic episodes, day time drowsiness, and such. ● Discuss work and personal time management to avoid overexer- tion and/or emotional stress. ● Provide factual information on al- ternative therapies if appropriate and ensure that the employee is communicating with personal health care provider regarding other treatment modalities such as herbal substances, acupuncture, trigger-point injections, self- hypnosis, and massage. ● Discuss coping strategies and assess for signs of depression. Consider the need for an EAP re- ferral or referral to an appropriate counselor. Refer to Guideline 31, Depression, page 72. Objectives Clinical Assessments and Interventions Referral for Medical Action 65 Conduct a thorough health assessment. Provide symptom relief. ● Obtain a detailed history of symptoms, in- cluding duration of complaints treatments tried and effectiveness activities of daily living and sleeping, nutritional, and exer- cise patterns. ● Assess vital signs, including temperature, pulse, and blood pressure. ● If appropriate, screen for diabetes and anemia or refer for testing. Other tests to consider include those for hypothyroidism and white blood cell count. ● Administer analgesics per standing order. Guideline continues on next page