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Below is a template for an ADA (Americans with Disabilities Act) form that a doctor or healthcare provider might use in a workplace setting. This template provides a structure that can be adapted to specific needs and situations.
Date: _____________________________________________________________. A sample form for an employee to request an accommodation due to disability.
A sample form for a health care provider to complete when an employee requests an ADA accommodation.
This template is designed for employees or applicants to formally request accommodations for disabilities as per the Americans with Disabilities Act (ADA) and the Rehabilitation Act, detailing their specific needs, impairment nature, desired accommodations, and necessary medical documentation (employees only).
14 paź 2021 · This handout includes sample documentation healthcare professionals can customize for patients who are seeking workplace accommodations.
JAN offers tools that may be useful to employers in the process of requesting medical documentation. See JAN's Medical Inquiry in Response to an Accommodation Request and JAN's Practical Guidance for Medical Professionals: Providing Sufficient Medical Documentation in Support of a Patient's Accommodation Request.
Sufficient Medical Documentation in Support of a. Patient’s Accommodation Request • Who Can Provide Medical Documentation for ADA Purposes? • What Does “Sufficient” Mean? A Deconstructive Series for ADA Terminology • Avoiding “The Waiting Place” After Requesting Medical Information • Providing Temporary Accommodation Solutions ...
