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Medical Reasonable Accommodation Request Intake Form
Vanderbilt University Medical Center (SUMC) provides reasonable accommodation(s) to qualified employees with
disabilities. SUMC complies with the
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How to fill out medical reasonable accommodation request
How to fill out medical reasonable accommodation request
01
To fill out a medical reasonable accommodation request, follow these steps:
1. Begin by clearly stating your personal information such as your name, contact details, and employee identification number (if applicable).
2. Next, mention the specific medical condition or disability for which you are seeking accommodation.
3. Describe in detail the limitations or challenges you face in performing your job tasks due to your medical condition or disability.
4. Clearly state the accommodations you are requesting, making sure to explain how each accommodation will enable you to perform the essential functions of your job.
5. Provide any supporting documentation or medical records that validate your medical condition and need for accommodation.
6. Sign and date the request form, and keep a copy for your records.
7. Submit the request to your employer's human resources department or the designated individual responsible for handling accommodation requests.
8. Follow up with your employer to ensure that your request is being considered and to discuss any necessary adjustments or additional information.
02
Please note that the specific process and requirements may vary depending on your employer's policies and applicable laws. It's always a good idea to consult your employee handbook or contact your HR department for guidance on how to fill out the medical reasonable accommodation request form.
Who needs medical reasonable accommodation request?
01
Individuals who have a medical condition or disability that affects their ability to perform job tasks may need to submit a medical reasonable accommodation request. This includes employees who require modifications in their work environment, schedule, job duties, or equipment to enable them to perform the essential functions of their job.
02
Examples of individuals who may need to submit a medical reasonable accommodation request include those with physical disabilities, chronic illnesses, mental health conditions, hearing or vision impairments, or pregnancy-related conditions. It is important to remember that the need for accommodation should be based on a certified medical condition or disability.
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What is medical reasonable accommodation request?
An accommodation request made by an individual with a disability to meet their medical needs.
Who is required to file medical reasonable accommodation request?
Any individual with a disability who requires accommodations to perform essential job functions.
How to fill out medical reasonable accommodation request?
The request can be filled out by providing medical documentation of the disability and explaining the necessary accommodations.
What is the purpose of medical reasonable accommodation request?
The purpose is to provide individuals with disabilities equal access to employment opportunities by accommodating their medical needs.
What information must be reported on medical reasonable accommodation request?
Medical documentation of the disability and specific accommodations needed.
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