Get Disabled Parking Request Medical Verification Form

The Disabled Parking Request Medical Verification Form is essential for individuals seeking accessible parking accommodations. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the patient's name in the designated field. This should be the full legal name of the individual requesting disabled parking accommodations.
3. Next, specify the diagnosis. Clearly annotate the medical condition that necessitates the request for disabled parking.
4. Provide the date of diagnosis in the format requested. Accurate information enhances the credibility of the request.
5. Indicate the duration of the impairment by checking either 'Long-term' or 'Permanent.' If the impairment is not permanent, specify the anticipated duration of the condition.
6. Answer whether the impairment affects a major life activity by selecting 'Yes' or 'No.' If 'Yes,' check all affected activities from the provided list.
7. Confirm whether the patient is limited in one or more major life activities by selecting 'Yes' or 'No.'
8. Detail any prescribed medications, including quantity or dosage and anticipated side effects that may impact the employee in the work environment.
9. If applicable, include a copy of the treatment plan, if the patient is following one.
10. Ensure the certifying physician's name, medical facility information, and contact details are provided accurately.
11. The physician must sign and date the form to verify the information provided.
12. Once all sections are completed, save your changes in the online editor. You can then download, print, or share the completed form as needed.

Complete your documents online today for a smoother and more efficient process.