Home
Forms Library
Accommodation request medical inquiry

Accommodation Request: Medical Inquiry Form (00209596-2) DOCX 2025

accommodation request medical inquiry Preview on Page 1

See details

4.7 out of 5

52 votes

The document is a Medical Inquiry Form from the Office of Employment Equity at Rutgers University, designed for staff members to request medical information from their healthcare providers as part of the accommodation process under the Americans with Disabilities Act (ADA) and New Jersey Law Against Discrimination (NJLAD). It includes sections for employees to provide consent and details about their requested accommodations, as well as questions for healthcare providers regarding the employee's disability, its impact on daily activities and job functions, and potential accommodations.

Here's how it works

01. Edit your accommodation request medical inquiry online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send nj accommodation request medical via email, link, or fax. You can also download it, export it or print it out.

How to modify Accommodation Request: Medical Inquiry Form (00209596-2) DOCX online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making changes to your paperwork takes only some simple clicks. Make these quick steps to modify the PDF Accommodation Request: Medical Inquiry Form (00209596-2) DOCX online free of charge:

Register and log in to your account. Log in to the editor with your credentials or click on Create free account to examine the tool’s functionality.
Add the Accommodation Request: Medical Inquiry Form (00209596-2) DOCX for redacting. Click on the New Document button above, then drag and drop the document to the upload area, import it from the cloud, or using a link.
Change your file. Make any changes needed: add text and images to your Accommodation Request: Medical Inquiry Form (00209596-2) DOCX, highlight information that matters, remove sections of content and replace them with new ones, and insert icons, checkmarks, and areas for filling out.
Finish redacting the template. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the parties involved.

Our editor is super easy to use and effective. Give it a try now!

See more Accommodation Request: Medical Inquiry Form (00209596-2) DOCX versions

We've got more versions of the Accommodation Request: Medical Inquiry Form (00209596-2) DOCX form. Select the right Accommodation Request: Medical Inquiry Form (00209596-2) DOCX version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.7 Satisfied (52 Votes)
2011	4.5 Satisfied (42 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

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

How do I write a proof of accommodation letter?

The Invitation Letter should include the following details: Dates of your stay. Address of the place where you will be staying. Name and Surname of your host. Contact details of your host, such as email and telephone number. Signature of your host. The area of the place and the number of members living there.

How do you write a reasonable accommodation letter for housing?

Letter to Request a Reasonable Accommodation I am your tenant at [apartment address]. I am writing to request a reasonable accommodation pursuant to the Fair Housing Act so that I can equally enjoy and use my apartment. I am a person with a disability because [elements of impairment] affect my daily living activities.

How to fill out accommodation request form?

Sample Accommodation Request 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.

What is an example of an accommodation request?

Example A: An employee tells her supervisor, Im having trouble getting to work at my scheduled starting time because of medical treatments Im undergoing. This is a request for a reasonable accommodation.

How to fill out a reasonable accommodation request form?

In your reasonable accommodation letter, you should provide all the information your employer will need to begin the accommodation process, including what your disability is, how it affects you, which aspects of your job might require modification, and proposed accommodations.