Get Rutgers University Accommodation Request: Medical Inquiry Form 2018-2026

This guide provides you with a clear and supportive approach to completing the Rutgers University Accommodation Request: Medical Inquiry Form online. Follow each step to ensure that your accommodation request is submitted accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the accommodation request form and open it in the designated editor.
2. In the section labeled 'TO BE COMPLETED BY THE EMPLOYEE,' fill in your name, title, phone number, and email address. Provide a brief description of the requested accommodation to help clarify your needs.
3. Sign the form to consent that your treating healthcare provider may complete the medical questionnaire and that your private medical information may be shared with Rutgers University.
4. The healthcare provider will need to complete their section of the form. They should indicate if you have a disability by checking 'Yes' or 'No' and describe the nature of your disability if applicable.
5. Your healthcare provider must also specify whether your disability is temporary or permanent. If it is temporary, they should provide an estimated duration.
6. Your healthcare provider needs to answer questions regarding how the disability affects your daily activities and job functions. They should check 'Yes' or 'No' and provide a description if necessary.
7. The healthcare provider can suggest reasonable accommodations that would enable you to perform your essential job functions. This section is critical for facilitating your request.
8. There is a space for additional comments or observations that your healthcare provider may wish to include. This can help the university understand your needs better.
9. After the form is completed, ensure that it is signed by your healthcare provider, including their specialty, contact details, and date.
10. Upload the completed form through the designated online portal or mail or fax it to the Office of Employment Equity using the provided contact details.
11. Once you have submitted the form, you can save any changes, download a copy for your records, print it out, or share it as needed.

Take the first step towards securing your accommodation by filling out the form online today.