Reasonable Accommodation Request Medical Certification

Last Updated	April 11, 2024
Total Files	1
Version	04.24

This form should be provided to employees to pass on to their healthcare provider in order to obtain medical certification regarding accommodation(s). Please see the Easy Steps for a full guide on the Reasonable Accommodation packet.

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Reasonable Accom. Request Medical Cert_2.LOAR.1122.01-.pdf

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Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.

Reasonable Accommodation Request Medical Certification

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