Loading
Form preview picture

Get VA 0857e 2013

At present we only need the following information a the nature severity and duration of the impairment b one or more of the activities the impairment limits walking reaching breathing etc. VA FORM SEP 2013 0857e c the extent or degree to which the impairment limits an activity d the reason the individual requires accommodation or the particular accommodation requested and/or e how the accommodation will assist the individual in applying for a job performing the essential functions of the job or to enjoy a benefits of employment. REQUEST FOR MEDICAL DOCUMENTATION 1. DATE 2. Dear Health Care Provider Your patient has requested an accommodation describe the requested accommodation here because of functional limitations caused by his/her disability. Since the disability is not visible and we do not have documentation on file I would appreciate information that would allow me to determine whether this individual has a disability covered by the Rehabilitation Act of 1973. The information that you provide will also help me determine whether the requested accommodation will be effective in eliminating or minimizing the limitations caused by the disability. 3. The key duties that your patient has advised that he/she is unable to perform or benefits and privileges of employment that he/ she is unable to enjoy are 4. I have been given the responsibility for determining if your patient is covered by the Rehabilitation Act. I cannot proceed until I receive the requested information* If you have any questions please contact me at the telephone number below. 5. MY NAME IS 6. MY PHONE NO. IS 7. MY TITLE IS 8. Please return this form and the requested information to me at Enter complete mailing address and fax number. 9. Please do NOT provide a copy of the patient s complete medical history. The Genetic Information Nondiscrimination Act of 2008 GINA prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual except as specifically allowed by this law. To comply with this law we are asking that you not provide any genetic information when responding to this request for medical information* Genetic information as defined by GINA includes an individual s family medical history the results of an individual s or family member s genetic tests the fact that an individual or an individual s family member sought or received genetic services and genetic information of a fetus carried by an individual or an individual s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services. 10. NAME OF HEALTH CARE PROVIDER 11. SIGNATURE OF HEALTH CARE PROVIDER 12. DATE OF SIGNATURE 13. MEDICAL/PROFESSIONAL LICENSE CATEGORY AND NUMBER This form should be retained separately from the employee s Official Personnel Folder. REQUEST FOR MEDICAL DOCUMENTATION 1. DATE 2. Dear Health Care Provider Your patient has requested an accommodation describe the requested accommodation here because of functional limitations caused by his/her disability. Since the disability is not visible and we do not have documentation on file I would appreciate information that would allow me to determine whether this individual has a disability covered by the Rehabilitation Act of 1973. .

How It Works

0857e rating
4.88Satisfied
476 votes

How to fill out and sign va form 0857 online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Finding a authorized specialist, creating an appointment and going to the workplace for a personal conference makes finishing a VA 0857e from beginning to end tiring. US Legal Forms allows you to rapidly produce legally-compliant papers according to pre-built browser-based samples.

Execute your docs in minutes using our simple step-by-step instructions:

  1. Get the VA 0857e you require.
  2. Open it using the online editor and start editing.
  3. Fill in the empty areas; engaged parties names, addresses and phone numbers etc.
  4. Change the blanks with smart fillable fields.
  5. Put the date and place your e-signature.
  6. Click Done following double-checking everything.
  7. Save the ready-made papers to your system or print it out as a hard copy.

Quickly create a VA 0857e without having to involve experts. We already have more than 3 million customers making the most of our unique library of legal documents. Join us right now and gain access to the #1 catalogue of web blanks. Try it out yourself!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing va form 0857a

Our video guide regarding how to complete Form online will help you get the done work fast and error-free. Don't bother, it only takes a short time from start to finish.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Norton logo picture

    Norton Secured

    The highest level of recognition among eCommerce customers.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.