ࡱ> /2. bjbj'' EMMMMjTT$$$$$8888p8At{{{,g${{{{{$${X$${8F0AII${{{{{{AI{{{{{{{{{T :   Sample Letter from Health Care Provider Supporting Need for Accommodation Under ADA or FEHA Other Than Leave of Absence Your Health Care Providers Letterhead [Date] To Whom It May Concern: I am the treating [job title or description, such as physician, psychiatrist, psychologist, therapist, social worker, case worker, or health care professional] for [name of employee or applicant]. [Name] has [optional: name or description of employees medical condition,] a medical condition that [substantially*] limits [Name]s major life activities, including [fill in relevant major life activities, such as: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, or the operation of major bodily function]. As a result of [Name]s disability, [she/he] seeks an accommodation from [employer]. [Describe situation and how accommodation will assist employee by enabling him/her to perform job or to maintain health.] [Example 1] As a result of [Name]s disability, she occasionally experiences episodes of disorientation and dizziness. During these episodes, [Name] must sit or lie down for a few minutes to recover. Therefore, [Name] needs, as an accommodation, permission to take these short breaks. [Example 2] As a result of [Name]s disability, [she/he] is extremely sensitive to distractions, including noise, colors and light. When these distractions are present, [Name] has difficulty concentrating on [his/her] job. Therefore, [Name] needs, as an accommodation, a workspace in which these distractions are reduced. Signature and license number *Federal law (the ADA) requires that the condition substantially limit a major life activity. State law (the FEHA) requires that the condition limit a major life activity.     (3J\xy   1 2 W Y h n jkmnpqȿȶȭȿȿȿȿȿȿțțȿ~z~z~hF>jhF>Uhh.aJ hsaJ h.aJhhsaJhh MaJhhB0aJhh|] aJhhzRaJhh/aJh/h/5CJ h/6aJh/h/6aJ h+6aJh/h/5CJaJ0(\xy X Y + , K L gdsgd/$a$gd/jlmoprsuvwxyz{|}~gd/gdsqstvwxyz{|}~hhsaJhZoBhjhF>UhF>gdsC0PPP:pzR/ =!"#`$% Dp666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~8XV~_HmH nH sH tH L`L Normal5$7$8$9DH$CJ_HmH sH tH DA`D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List 4@4 Header  !4 @4 Footer  !6U6 G0 Hyperlink >*B*phPK!pO[Content_Types].xmlj0Eжr(΢]yl#!MB;.n̨̽\A1&ҫ QWKvUbOX#&1`RT9<l#$>r `С-;c=1g~'}xPiB$IO1Êk9IcLHY<;*v7'aE\h>=^,*8q;^*4?Wq{nԉogAߤ>8f2*<")QHxK |]Zz)ӁMSm@\&>!7;wP3[EBU`1OC5VD Xa?p S4[NS28;Y[꫙,T1|n;+/ʕj\\,E:! t4.T̡ e1 }; [z^pl@ok0e g@GGHPXNT,مde|*YdT\Y䀰+(T7$ow2缂#G֛ʥ?q NK-/M,WgxFV/FQⷶO&ecx\QLW@H!+{[|{!KAi `cm2iU|Y+ ި [[vxrNE3pmR =Y04,!&0+WC܃@oOS2'Sٮ05$ɤ]pm3Ft GɄ-!y"ӉV . `עv,O.%вKasSƭvMz`3{9+e@eՔLy7W_XtlPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-!pO[Content_Types].xmlPK-!֧6 -_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!!Z!theme/theme/theme1.xmlPK-! ѐ'( theme/theme/_rels/themeManager.xml.relsPK]#  q  8@0( - ) B S  ?ijlmoprsuvjlmoprsuv|c ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  p^ `OJQJo(  @ ^ `OJQJo( x^x`OJQJo(H^H`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(32|] ZX2!W0*+q-L.B0KZ05ZoBGII MMzRn,X B^#rass@v"l}p:DEX)#/R/>:T+x8:MG.[]v :Vl_ky5F>pUjl@{x@UnknownG*Ax Times New Roman5Symbol3 *Cx Arial? *Cx Courier New;WingdingsA$BCambria Math"h%g%g1[GO O %xxr0gg3qHP $Pl2!xx ,@11 -- Sample doctor's letter -- RA other than LOA (00340323).DOCClaudia CenterDaniel Mahoney  Oh+'0(< T`    'D11 -- Sample doctor's letter -- RA other than LOA (00340323).DOCClaudia Center Normal.dotmDaniel Mahoney2Microsoft Macintosh Word@@ޡf@D@DO ՜.+,0`x  A'[Compatibility Mode]f g A11 -- Sample doctor's letter -- RA other than LOA (00340323).DOC Title  !"#$%'()*+,-014Root Entry Fa#931TableYWordDocument ESummaryInformation(DocumentSummaryInformation8&MsoDataStorec67UKDGTMEROY4DEGJUA==26q7Item PropertiesUCompObj `  F Microsoft Word 97-2004 DocumentNB6WWord.Document.8