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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.
Get up to speed with the ADA reasonable accommodation and learn how to manage requests. Download our free checklist template and request form for HR!
If you are not sure what accommodation is needed, do you have any suggestions about what options we can explore? Provide the name, address, telephone and fax numbers of your health care...
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).
A sample form for a health care provider to complete when an employee requests an ADA accommodation.
This form is commonly used to obtain information from a healthcare provider to substantiate that an employee has a medical impairment, associated limitations, and requires accommodation under the ADA.
14 paź 2021 · This handout includes sample documentation healthcare professionals can customize for patients who are seeking workplace accommodations.
