Va Form 0857E PDF Details

In the intricate landscape of employment and disability law, the VA Form 0857E stands as a critical document designed to bridge the gap between employees with disabilities and their participation in the workforce. This form serves as a formal request for medical documentation from healthcare providers, underlining the necessity of understanding an employee's functional limitations due to invisible disabilities. Its foundation is set upon the principles of the Rehabilitation Act of 1973, emphasizing the act's commitment to accommodate individuals with disabilities in the workplace. The form meticulously outlines the process of requesting detailed information about the nature, severity, and impact of an individual’s disability without overstepping into the boundaries of genetic information, adhering to the restrictions imposed by the Genetic Information Nondiscrimination Act of 2008 (GINA). By doing so, it meticulously avoids soliciting comprehensive medical histories or genetic information, highlighting only the essential data needed to assess the necessity and efficacy of the requested accommodations. The information gathered through this form is pivotal in determining whether an employee's condition qualifies under the Rehabilitation Act and, consequently, in orchestrating effective workplace adjustments. It underscores the dual aim of protecting the privacy of individuals with disabilities while ensuring their rightful accommodations are met, facilitating an inclusive work environment. Furthermore, this form encapsulates the responsibilities of the requesting party, the necessity of healthcare providers’ input, and the legal framework guiding this sensitive exchange of medical documentation for accommodations in the employment sphere.

QuestionAnswer
Form NameVa Form 0857E
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesva form 0857e pdf, 0857e, va 0857a, how to request medical documentation

Form Preview Example

REQUEST FOR MEDICAL DOCUMENTATION

1.DATE

2.Dear Health Care Provider:

Your patient

has requested an accommodation (describe the requested accommodation here)

because of functional limitations caused by his/her disability. Since the disability is not visible, and we do not have documentation on file, I would appreciate information that would allow me to determine whether this individual has a disability covered by the Rehabilitation Act of 1973. The information that you provide will also help me determine whether the requested accommodation will be effective in eliminating or minimizing the limitations caused by the disability.

3.The key duties that your patient has advised that he/she is unable to perform, or benefits and privileges of employment that he/ she is unable to enjoy are:

4.I have been given the responsibility for determining if your patient is covered by the Rehabilitation Act. I cannot proceed until I receive the requested information. If you have any questions, please contact me at the telephone number below.

5. MY NAME IS

6. MY PHONE NO. IS

7. MY TITLE IS

8. Please return this form and the requested information to me at:

(Enter complete mailing address and fax number.)

9.Please do NOT provide a copy of the patient's complete medical history.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by

GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. `Genetic information' as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

At present, we only need the following information:

(a)the nature, severity, and duration of the impairment;

(b) one or more of the activities the impairment limits (walking, reaching, breathing, etc.);

VA FORM 0857E SEP 2013

(c) the extent or degree to which the impairment limits an activity;

(d) the reason the individual requires accommodation or the particular accommodation requested, and/or

(e)how the accommodation will assist the individual in applying for a job, performing the essential functions of the job, or to enjoy a benefits of employment.

10. NAME OF HEALTH CARE PROVIDER

11. SIGNATURE OF HEALTH CARE PROVIDER

12. DATE OF SIGNATURE

13. MEDICAL/PROFESSIONAL LICENSE CATEGORY AND NUMBER

This form should be retained separately from the employee's Official Personnel Folder.

VA FORM 0857E, SEP 2013, BACK

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1. Begin filling out your requested gina please pdf with a group of major blank fields. Note all the important information and make certain there's nothing neglected!

Part # 1 in submitting va 0857a

2. Soon after filling out the last step, go on to the subsequent part and fill in the essential details in all these blank fields - Please return this form and the, Enter complete mailing address and, Please do NOT provide a copy of, b one or more of the activities, a the nature severity and duration, VA FORM, and SEP e.

Filling in segment 2 of va 0857a

In terms of SEP e and Please do NOT provide a copy of, be sure you double-check them here. Both of these are the most significant ones in this document.

3. The next section should also be rather straightforward, c the extent or degree to which, d the reason the individual, e how the accommodation will, NAME OF HEALTH CARE PROVIDER, SIGNATURE OF HEALTH CARE PROVIDER, DATE OF SIGNATURE, and MEDICALPROFESSIONAL LICENSE - these blanks has to be filled out here.

Completing part 3 in va 0857a

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