Wisconsin 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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  • Preview ADA Medical Documentation for Use by Medical Practitioner
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How to fill out ADA Medical Documentation For Use By Medical Practitioner?

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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.

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.

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.

During recruitment, employers may ask individuals to outline any pre-existing injury or illness that they believe may affect their ability to perform the normal duties of the role in writing.

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...

Yes. An employer cannot ask for documentation when: (1) both the disability and the need for reasonable accommodation are obvious, or (2) the individual has already provided the employer with sufficient information to substantiate that s/he has an ADA disability and needs the reasonable accommodation requested.

What to Include in Your Reasonable Accommodation LetterYour name and position.The date.Information about your disability.A request for accommodation.Accommodation ideas.Medical information.

Reasonable documentation means that the employer may require only the documentation that is needed to establish that a person has an ADA disability, and that the disability necessitates a reasonable accommodation.

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...

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Wisconsin ADA Medical Documentation for Use by Medical Practitioner