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VA0857e, REQUEST FOR MEDICAL DOCUMENTATION 0857e, Reasonable, Accommodation, MEDICAL, DOCUMENTATION, 2025

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The document is a request for medical documentation from a healthcare provider regarding a patient's accommodation needs due to a non-visible disability. It outlines the necessary information required to determine if the patient is covered by the Rehabilitation Act, including details about the impairment and how it affects the patient's ability to perform job-related activities. The document emphasizes compliance with the Genetic Information Nondiscrimination Act (GINA) by prohibiting the inclusion of genetic information in the response.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'DATE' at the top of the form. This is essential for tracking purposes.
In the 'DUE TO RAC BY' section, specify the deadline for submitting the requested medical documentation.
Address the health care provider in the designated area and include your patient's name where indicated.
Describe the requested accommodation clearly in the space provided, ensuring to mention any functional limitations due to their disability.
List key duties or benefits that your patient is unable to perform or enjoy due to their condition in section four.
Complete your contact information including 'RAC NAME', 'PHONE NO.', and 'TITLE' for follow-up inquiries.
Provide instructions for returning this form via encrypted email or mail, ensuring you include all necessary contact details.
Fill out sections regarding health care provider details including name, signature, license category, and expiration date.

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Versions	Form popularity	Fillable & printable
2022	4.2 Satisfied (46 Votes)
2013	4.9 Satisfied (476 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a bad example of reasonable accommodation?

Examples of accommodations that may be deemed unreasonable include the following: Eliminating a primary job responsibility. Lowering production standards applied to other employees. Providing more paid leave to an employee with a disability than provided to other employees.

What qualifies as a reasonable accommodation?

Under Title I of the Americans with Disabilities Act (ADA), a reasonable accommodation is a modification or adjustment to a job, the work environment, or the way things are usually done during the hiring process.

How do I request a medical documentation from the VA?

How to submit a medical records request. Youll need to fill out an Individuals Request for a Copy of Their Own Health Information (VA Form 10-5345a). Submit your completed form to your VA health facilitys medical records office. This office is also called a Release of Information Office.

How to write up a reasonable accommodation request?

Content to consider in body of letter: Identify 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.

When requesting a reasonable accommodation based on a disability?

Asking for reasonable adjustments Anyone whos disabled and who needs a reasonable adjustment should talk with their manager or employer (or their potential employer if theyre applying for a job). This is so: the person can explain their situation. the employer can understand how they can help.

va form 0857e

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What is the VA 70 40 rule for disability?

The VA 70/40 rule for TDIU requires veterans to have a combined disability rating of 70% or higher and at least one service-related disability rated at 40% or higher to be eligible for Total Disability based on Individual Unemployability (TDIU) benefits.

What is the VA reasonable accommodation policy?

Reasonable Accommodation The Department of Veterans Affairs (VA) provides reasonable accommodations for qualified individuals, including job applicants and employees with disabilities, unless doing so would cause undue hardship.