Guidance for healthcare staff
Support for physicians and other healthcare professionals when issuing a medical statement (läkarutlåtande) for a seriously ill child.
Table of contents
Purpose
This guidance has been developed to facilitate the assessment and documentation when issuing certificates for temporary parental benefit (VAB – tillfällig föräldrapenning) (VAB) for the care of a seriously ill child.
Experience indicates that many families receive refusals or requests for additional information, despite the child having extensive care and nursing needs. This is often because critical information is not clearly stated in the medical certificate.
What is important to describe?
Do not describe the diagnosis alone.
Swedish Social Insurance Agency (Försäkringskassan)'s assessment is also based on:
- •The child's current state of health
- •Need for care, rehabilitation (rehabilitering) and follow-up
- •The extent of the parents' nursing contributions
- •The content and intensity of the treatment
- •The child's age
- •Whether the child can participate in regular pre-school, school or leisure activities
- •Whether the child is dependent on a parent's presence during the day
HFD 2013 ref. 76
Landmark ruling by the Supreme Administrative Court (HFD – Högsta förvaltningsdomstolen)
The Supreme Administrative Court (HFD) established that a child may be considered seriously ill even after active treatment has ended.
The court emphasised that several factors must be weighed together:
- •The child's current medical condition
- •The connection to the acute phase of the illness
- •How demanding the care is
- •The support the child needs from their parents
- •The child's age
- •The content and intensity of the treatment
The court found that a child who had completed treatment for a brain tumour was still seriously ill, as the child had extensive residual complications, intensive rehabilitation and a need for a parent's full-time presence.
Completion of treatment does not necessarily mean recovery
The completion of a treatment does not automatically mean that the child is no longer seriously ill.
If the child has:
- •Residual neurological damage
- •Functional disabilities
- •Complications following treatment
- •Extensive rehabilitation (rehabilitering)
- •Regular medical check-ups
this should be clearly described in the certificate.
Suspected serious illness
Försäkringskassan has clarified that temporary parental benefit (VAB) for a seriously ill child can also be granted during an ongoing investigation.
The condition is that the suspicion of serious illness is medically justified and stated in the medical statement (läkarutlåtande).
It is therefore important to describe:
- •Which serious illness or diagnostic category is suspected
- •Why the suspicion exists
- •What investigative measures are planned or being carried out
- •Why the child's condition is assessed as potentially life-threatening
Key formulations
The following types of information are often valuable:
"The child cannot attend regular school or pre-school."
"The child is dependent on a parent's presence for most of the day."
"The child requires extensive nursing and support as a result of the illness and its treatment."
"The child is undergoing intensive rehabilitation following treatment for serious illness."
"The child's current condition is a direct consequence of the serious illness or its treatment."
"A parent needs to be absent from work to meet the child's care and nursing needs."
Common shortcomings in certificates
Avoid overly brief formulations such as:
- ✗"Treatment completed."
- ✗"Check-ups are planned."
- ✗"Needs rehabilitation."
Instead, describe the extent, consequences and need for parental involvement.
Checklist
A well-formulated medical certificate reduces the risk of requests for additional information and helps ensure that the family receives a fair, consistent and legally sound assessment.
Knowledge support for physicians
Medical statement for a seriously ill child
Medical assessment and division of responsibilities between healthcare providers and the Swedish Social Insurance Agency (Försäkringskassan). Knowledge support version 1.0.