Get Medical Condition Request Form

This guide provides clear and supportive instructions for completing the Medical Condition Request Form online. By following these steps, you will be able to provide the necessary information about medical conditions that may affect participation in WorkFirst activities.

Follow the steps to successfully fill out the Medical Condition Request Form online.

1. Click the ‘Get Form’ button to access the Medical Condition Request Form and open it in your preferred online document editor.
2. Begin filling out the client name, date of birth, and client identification number in the designated fields to accurately identify the individual in question.
3. If the patient being evaluated is different from the client, provide the name of the patient in the relevant section.
4. Indicate whether the client has physical, mental, emotional, or developmental conditions that require special accommodations by checking the appropriate box.
5. If applicable, specify the type of condition and provide any supporting documentation, such as testing or lab reports.
6. Describe any specific limitations the client may experience in working, looking for work, or preparing for work, and indicate the number of hours per week they can participate.
7. Fill out details regarding any limitations with lifting and carrying, choosing from the options provided to specify how these limits affect the client's work capabilities.
8. Answer questions about whether the client's condition impacts their ability to access services and provide descriptions as needed.
9. Complete sections that address whether the condition is permanent and detail any planned treatment or assessment requirements.
10. Sign the form and include the date, along with the printed name and title of the medical or mental health care provider.
11. After reviewing all the information for accuracy, save changes, and download or print the completed form to share it with the appropriate recipient.

Complete your documents online today to ensure timely processing and support.