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The document is a confidential workplace accommodation medical form designed for employees at the University of Kansas to request job accommodations under the Americans with Disabilities Act (ADA). It includes sections for the employee to authorize their medical provider to provide information about their medical condition, its impact on their work, and recommended accommodations. The form also addresses specific COVID-19 related accommodations and requires signatures from both the employee and their healthcare provider.
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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.
Under the ADA, in response to an accommodation request, an employer may ask what impairment is involved, why medication is needed, and its impact on job performance.
Sufficient medical documentation should describe the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employees ability to perform the activity or activities, and should also substantiate why the requested reasonable
An individual meets the Americans with Disabilities with Act definition act of disability that would qualify them for reasonable accommodations if they have a physical or mental impairment that substantially limits one or more major life activities (sometimes referred to in the regulations as an actual disability)
The California Fair Employment and Housing Act requires employers of five or more employees to provide reasonable accommodation for individuals with a physical or mental disability to apply for jobs and to perform the essential functions of their jobs unless it would cause an undue hardship.

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A detailed, comprehensive written report from your treating professional describing your disability and its impact on your daily functioning. The report should also explain the need for the requested accommodations relative to your impairment.
The first step in the reasonable accommodation process is disclosure of a disability, as employers are only required to accommodate disabilities of which they are aware.

Related links

Accommodation Request Medical Certification

This form (or a similar letter that addresses the information requested) must be completed and signed by the treating health care provider.

Learn more
ACCOMMODATIONS REQUEST PACKET

Request Prometric accommodations by fax (410-385-8504) or mail (7941 Corporate Drive, Nottingham, MD 21236). Includes forms for candidate and professional evaluation. Call 1-800-967-1139. Valid for 1 year.

Learn more
REASONABLE ACCOMMODATION REQUEST MEDICAL

The following forms used in the NIH Reasonable Accommodation Program are attached: ➢ The Medical Documentation Fact Sheet provides an overview of the medical.

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