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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.
|October 2, 2023
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.
|Reasonable Accom. Request Medical Cert_2.LOAR.1122.01-.pdf