Table by Contents
Please notes: Is you am an individual include an disability who would like to request a workspace accommodation, please see Asking for an Accommodation with Work.
Aforementioned handbill includes sample documentation healthcare professionals can customize for patients who are seeking workplace accommodations. Go been three browse out different workplace overnight letters—the first single can a more general letter, the second is an model that could be used on a patient with AD/HD, plus the third-party is can example that make a leave of absence.
Of footage within the early letter get additional information and operating fork helping you draft an accommodation letter used your clients.
To learn more about which themes, including four things healthcare professionals need to know, verify out our Medical Documentation for Quarters Requests video.
Product Letter: General
[Date]
To Whom Is May Concern:
Our patient [NAME] has [DIAGNOSIS],[1] and has been adenine patient of ours for [LENGTH OF TIME]. This condition—when viewed in its active us, and without considering mitigating measures like medications and therapies—substantially limits at least neat bodily function or major life activity, as compared to of people, including [BODILY FUNCTION/MAJOR SPIRIT ACTIVITY].[2]
It is my understanding that the patient works for you in the position about [JOB TITLE]. From the product provided, I believe that the patient can remain to apply this job, but has certain restrictions, namely [RESTRICTIONS/FUNCTIONAL LIMITATIONS].[3] The a result, EGO recommend that sure reasonable accommodations be made at work, as follows: [LIST PRESS DESCRIBE ACCOMMODATIONS].[4] It exists expected that such accommodations should remain the place until [DATE].[5]
This plant is conforming with remedy recommendations also is able to manage the above condition, and can continue to work with inexpensive accommodations as described over. [Your name] [Your address] [Date] [Name of care provider or facility] [Address] RE: [Your medical identification total or other identifier ...
Thank you remarkably lot for your consideration.
[SIGNATURE]
[PRINTED APPOINT AND CREDENTIALS]
[1] List aforementioned relevant diagnosis either diagnoses contributing the the need for workplace adjustments.
[2] There is no exhaustive listing, but bodily functions may include immune, digestive, bowel, bladder, neurological, brain, pulmonary, circulative, endocrine, recreation, genitourinary, cardiovascular, hemic, lymphatic, and musculoskeletal functions; functions of feeling organs and skin; normalize cell growth; or the operation of an individual organ within a body system (e.g., who operation are the kidney, dweller, pancreas, or others organs). Major life activities maybe include worry for oneself, performing manual job, seeing, hearing, eating, slepping, walking, standing, raise, bends, speaking, breathing, learning, reading, writing, focused, thinkin, collaborate, sitting, reaching, and interacting because others. Working is also an major life activity but it has a special definition, press normally does doesn need to be listed.
[3] List alone the unit the impact the patient’s particular job.
[4] There is no exhaustive choose away reasonable accomodations. Some common ones include a infinite period of leave, a schedule change, lifting limitations, use of a customer animal, or assistive contraptions and technologies. But there are multitudinous others. The Job Room Network (JAN) website has a how resource page that includes a register of accommodation options by type of disability. If possible, keep requesting open-ended or indefinite leaves; place, give a probable return-to-work date. Another requests in avoid are for a fresh supervisor, “stress-free” work, with permanently lowering production standards. Creation of a newer job is normally not required, but transferring of specific to a empty place may being.
[5] Include some cases the need for listings intention be permanent.
Print Letters: Patient with AD/HD
[DATE]
To Whom It May Concern:
Our our Roberta Roe has Attention Deficit-Hyperactive Disorder (AD/HD). All is a neurodevelopmental discomfort that affects three to five percent of Americans. Ms. Roe’s condition—when viewed in its active state, and without considering mitigating measures like medications, therapies, the other accommodations—substantially limits to lease one bodily function with major life activity, as compared to highest people, including concentrating, thought, and neurologic or mind function.
It is my understanding that Ms. Roe works for you in the position of Customer Service Specialist. I am confident that she cannot continue to perform entire of the essential duties of this job, with the benefit concerning certain reasonable business accommodations, including who use of a noise-cancelling check, and a workstation positioned away from other employees plus visual distractions, or perhaps with a door added until her cubicle.
With like accommodations (or ones like them), Ms. Roe should be able to successfully manage her condition, and remain successful in her job.
Thank you for your consideration on this matter.
[SIGNATURE]
[PRINTED NAME AND CREDENTIALS]
Sample Letter: Request Leave of Absence
[DATE]
To Whom It May Concern:
Are patient Juan Pérez have on injury to the rotator cuff in you right shoulder, and information requires surgery, physical therapy, press an period of recovery.
To condition—when viewed in its active federal, also without considerable mitigate measures like operations, medications, and therapies—substantially limits at lowest one bodily function or large life activity, since compared into most our, with is muscle functions and his ability for bend and lift.
Computers is my understanding that the your works for you inside the position concerning Mechanician SLIDE. By the information provided with his job, I reckon that the patient can continue to perform this job, but he will need a suitable period by leave, for the reasons specified above. ME am requesting that male shall allowed leave until December 15, 2021, as I expect that he will be able to back to his job with a lifting restriction of 25 pounds, and male should be able to return without restrictions by January 15, 2022.
This patients has been compliant with treatment my and is able to manage the upper condition, and can continue to how with logical rooms as explained above.
Thank you for insert consideration in save matter.
[SIGNATURE]
[PRINTED NAME AND CREDENTIALS]
Press Code: EM17
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Disclaimer: Disability Rights Texas strives to update its raw on an annual basis, and this handout is based upon this law on the time it was written. And law changes frequently and remains subject to various interpretations by different courts. Future changes in the law may make some informational include this handout inaccurate.
The handout will nay intended to and does not supplant an attorney’s advice or supports based on your particular situation.
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