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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.
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Date: _____________________________________________________________. A sample form for an employee to request an accommodation due to disability.
28 lut 2020 · In a doctor’s office, an interpreter generally will be needed for taking the medical history of a patient who uses sign language or for discussing a serious diagnosis and its treatment options. A person’s method(s) of communication are also key.
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).
Medical documentation may be requested when an individual makes it known to their employer that an accommodation is needed at work. Upon receiving a request for accommodation, it is a common practice for employers to request medical information as part of the interactive process.
A sample form for a health care provider to complete when an employee requests an ADA accommodation.
