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Office of Affirmative Action and Equal Opportunity Programs 3451 Walnut Street, Suite #421 The Franklin Building Philadelphia, PA 191046205REASONABLE ACCOMMODATION MEDICAL AUTHORIZATION FORM To Penn
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How to fill out reasonable accommodation medical authorization

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How to fill out reasonable accommodation medical authorization

01
To fill out a reasonable accommodation medical authorization, follow these steps:
02
Start by providing your personal information, including your full name, address, and contact details.
03
Specify the type of accommodation you are requesting and provide a detailed description of your medical condition or disability.
04
Indicate the time frame for which you are requesting the accommodation.
05
Include any medical documentation or supporting evidence that demonstrates the need for the requested accommodation.
06
If applicable, include information about any healthcare professionals involved in your treatment or diagnosis.
07
Sign and date the authorization form.
08
Submit the completed form to the appropriate party or department responsible for reviewing and granting reasonable accommodation requests.

Who needs reasonable accommodation medical authorization?

01
Reasonable accommodation medical authorization is needed by individuals with medical conditions or disabilities who require specific accommodations to perform their job duties or access services.
02
This may include individuals who need workplace adjustments, such as modified work schedules, ergonomic equipment, or changes to the physical environment.
03
It can also apply to individuals who require accommodations in public settings, such as accessible parking, assistive devices, or alternative communication methods.
04
The need for reasonable accommodation varies based on individual circumstances, and it is important for individuals to follow the appropriate process and provide necessary documentation to request such accommodations.
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Reasonable accommodation medical authorization is a form that allows an individual to provide medical information to support a request for accommodations in the workplace.
Employees who require accommodations in the workplace due to a medical condition are required to file reasonable accommodation medical authorization.
To fill out reasonable accommodation medical authorization, the employee must provide their medical information, details of the requested accommodations, and any supporting documentation.
The purpose of reasonable accommodation medical authorization is to ensure that employees with medical conditions are provided with the necessary accommodations to perform their job duties effectively.
Reasonable accommodation medical authorization must include the employee's medical diagnosis, treatment plan, and recommendations for accommodations from healthcare providers.
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