Nevada ADA Medical Documentation for Use by Medical Practitioner

State:
Multi-State
Control #:
US-AHI-209
Format:
Word; 
Rich Text
Instant download

Description

This AHI form is to be used by an employer who has hired a disabled employee. This form must be sent to the employees medical physician. This from includes the employees job description and functions preformed by the employee.
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FAQ

Examples of reasonable accommodations include: making the workplace accessible to and usable by an employee with a disability, restructuring a job, modifying work schedules, providing qualified readers for individuals who are blind, providing sign language interpreters to people who are deaf, providing periods of leave

Examples of reasonable accommodations include making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; providing qualified readers or interpreters; and reassignment to a vacant position.

This form is commonly used to obtain information from a healthcare provider to substantiate that an employee has a medical impairment, associated limitations, and requires accommodation under the ADA.

What types of accommodations are generally considered reasonable?Change job tasks.Provide reserved parking.Improve accessibility in a work area.Change the presentation of tests and training materials.Provide or adjust a product, equipment, or software.Allow a flexible work schedule.More items...

How To Request AccommodationsKeep it simple. You can tell your employer that you need an adjustment or change because of a medical condition.Put it in writing.Talk to the right people.How it works: an example.Finding help.19-Jul-2018

Sample Accommodation Request LetterIdentify yourself as a person with a disability.State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee)Identify your specific problematic job tasks.Identify your accommodation ideas.More items...

Dear Mr./Ms. (Contact at Human Resources Department): I work at (Company Name) as a (Your Job Title) and have been in this position since (Date). I am writing to request that you provide (list accommodation needed here) as a reasonable accommodation under the ADA.

I have been working in (Branch) since (Duration) holding employee ID (Employee ID). Through this letter, I would request you to kindly provide me with accommodation. I, on // (Date) got transferred to (Branch Address) branch and have no place to reside at.

Examples of accommodations include:sign language interpreters for students who are deaf;computer text-to-speech computer-based systems for students with visual impairments or Dyslexia;extended time for students with fine motor limitations, visual impairments, or learning disabilities;More items...?

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Nevada ADA Medical Documentation for Use by Medical Practitioner