Texas ADA Medical Documentation for Use by Medical Practitioner

State:
Multi-State
Control #:
US-AHI-209
Format:
Word
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

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.

Title I (Employment) Equal Employment Opportunity for Individuals with Disabilities.Title II (State and Local Government) Nondiscrimination on the Basis of Disability in State and Local Government Services.Title III (Public Accommodations)

Titles of the ADATitle Iemployment.Title IIpublic entities (and public transportation)Title IIIpublic accommodations (and commercial facilities)Title IVtelecommunications.Title V miscellaneous provisions.

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.

The ADA is divided into five titles:Employment (Title I)Public Services (Title II)Public Accommodations (Title III)Telecommunications (Title IV)Miscellaneous (Title V)

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...

Under the ADA , you have a disability if you have a physical or mental impairment that substantially limits a major life activity. The ADA also protects you if you have a history of such a disability, or if an employer believes that you have such a disability, even if you don't.

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...

The ADA requires employers to treat any medical information obtained from a disability-related inquiry or medical examination (including medical information from voluntary health or wellness programs (9)), as well as any medical information voluntarily disclosed by an employee, as a confidential medical record.

Have an equal opportunity to be promoted once they are working; have equal access to benefits and privileges of employment that are offered to other employees, such as employer-provided health insurance or training; and. must not be harassed because of their disability.

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Texas ADA Medical Documentation for Use by Medical Practitioner