Utah 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

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.

You can get a reasonable accommodation for any mental health condition that would, if left untreated, "substantially limit" your ability to concentrate, interact with others, communicate, eat, sleep, care for yourself, regulate your thoughts or emotions, or do any other "major life activity." (You don't need to

A provider letter can be written by a doctor, nurse, therapist, psychiatrist, case worker, social worker, or other professional familiar with your disability.

Does the Americans with Disabilities Act (ADA) provide a list of conditions that are covered under the act?Deafness.Blindness.Diabetes.Cancer.Epilepsy.Intellectual disabilities.Partial or completely missing limbs.Mobility impairments requiring the use of a wheel chair.More items...

An individual with epilepsy, paralysis, a substantial hearing or visual impairment, mental retardation, or a learning disability would be covered, but an individual with a minor, nonchronic condition of short duration, such as a sprain, infection, or broken limb, generally would not be covered.

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.

What Qualifies as an ADA Disability?AIDS, HIV and its symptoms.Asthma.Blindness or other visual impairments.Cancer.Cerebral palsy.Diabetes.Epilepsy.Heart Disease.More items...?

Accommodation ideas from the Job Accommodations Network include: For those with concentration issues, reduce distractions with white noise or environmental sound devices, noise cancelling headsets, modifications in lighting, allow for a flexible work environment or schedule.

Reasonable accommodations for anxiety can include remote work, a support animal, a rest area, a modified break schedule, a flexible schedule, and shifts in schedule. The type of anxiety you have, your limitations, and your employer's resources will determine what accommodation is appropriate.

Re: Request for Reasonable Accommodation for (Your Name)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.

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Utah ADA Medical Documentation for Use by Medical Practitioner